1.Diagnostic Value of Intracavernous papaverine-Induced Artificial Erection.
Korean Journal of Urology 1988;29(4):579-587
To determine whether intracavernous injection of papaverine can discriminate vascular versus psychogenic impotence 40mg papaverine were injected intracorporally into 203 importens. And the diagnostic usefulness of intracavernous papaverine-induced artificial erection was compared with Snap Gauge test, penile brachial index(PBI), internal pudendal angiography and cavernosography. The results obtained were as follows ; 1. Among the 119 psychogenic impotent patients, 104(87.4%) showed full rigid erection and 1(0.8%) soft or absent erection at 5 minutes after injection, and 88(73.8%) full rigid erection and 2(1.7%) soft or absent erection at 30 minutes after injection. Among 33 patients with arteriogenic impotence none showed full rigid erection and 20(60.6%) soft or absent erection at 30 minutes. Among 12 patients with venous leak only one(8.3 %) showed full erection at 5 minutes, and none fully rigid erection and 7(58.3%) soft or absent erection at 30 minutes. 2. Of the 78 patients with an abnormal Snap Gauge test, the response papaverine injection was absent in 37(47.4%) and fully rigid erection in 11(14.1%). Of the 105 patients with a normal Snap Gauge test the response was full erection in 89(84.7%) and absent in 2(1.9%). 3. Among 17 patients of PBI < 0.75, 14(82.4%) showed soft or full erection and one(5.9%) full erection with papaverine injection. Among 186 patients of PBI >=0.75, 26(13.9%) showed soft or absent erection and 113(60.7%) full erection with papaverine injection. 4. Among 27 patients with severe arterial lesion on arteriogram, the response to papaverine injection was absent in 18(66.7%) and full erection in one(3.7%). Among 20 patients with severe venous leak on cavernosogram the response to papaverine injection was absent in 12(60.6%) and full erection in one(5.0%). Therefore, we conclude intracavernous papaverine-induced artificial erection is the best valuable test for differentialdiagnosis of psychogenic and vasculogenic impotence.
Angiography
;
Erectile Dysfunction
;
Female
;
Humans
;
Impotence, Vasculogenic
;
Male
;
Papaverine
2.Diagnostic value of penile duplex sonography for arteriogenic impotence.
Kyeng Keun SEO ; Young Goo KIM ; Sae Chul KIM
Korean Journal of Urology 1991;32(2):294-300
Penile duplex sonography with intracorporeal papaverine injection has been proposed as a reliable noninvasive method to evaluate the cavernosal arteries. To provide insight into the clinical value of this test. penile duplex sonography was comparatively analyzed with penile brachial index. nocturnal penile erection and selective internal pudendal pharmacoangiography in 60 patients suggestive of arteriogenic impotence. The duplex sonogram, penile brachial index and angiogram of both cavernosal arteries were evaluated separately and compared each other. Cavernosal arteries were interpreted as normal by duplex scanning if the artery demonstrated a 75% or greater increase in diameter and systolic peak flow velocity of greater than 25 cm/sec after intracorporeal injection of 60 mg or papaverine HCI. There was no significant difference between the degree of arterial dilatation and peak flow velocity on penile duplex sonogram. Arterial dilatation and peak flow velocity did not correlate with nocturnal penile erection and cavernosal arteriogram. But peak flow velocity correlate with penile brachial index. In conclusion. although penile duplex sonography is a useful method to evaluate the cavernosal arteries. it alone can make an error to misdiagnose the arteriogenic impotence. Therefore supplementary tests should be added to the duplex sonography to avoid this error.
Arteries
;
Dilatation
;
Female
;
Humans
;
Impotence, Vasculogenic*
;
Male
;
Papaverine
;
Penile Erection
3.Clinical Significance of Transperineal Duplex Doppler Ultrasonography in the Diagnosis of Arteriogenic Impotence.
Gun Pyung KIM ; Kwang Sung PARK ; Soo Bang RYU
Korean Journal of Urology 2000;41(11):1384-1388
No abstract available.
Diagnosis*
;
Female
;
Impotence, Vasculogenic*
;
Male
;
Ultrasonography, Doppler, Duplex*
4.Reassessment of the Diagnostic Value of Penile-Brachial Index.
In Gyu CHOI ; Young Eun LEE ; Sae Chul KIM
Korean Journal of Urology 1989;30(4):569-575
Penile-brachial Index(P. B. I) was measured before and after injection of papaverine in 79 psychogenic impotences, 31 arteriogenic impotences and 11 neurogenic impotences. Its diagnostic usefulness was compared with qualities of papaverine induced artificial erection and pudendal angiographic findings. The results were as follows , 1. Among 31 patients with arteriogenic impotence, 17(54.8%) patients were above 0.8 in P. B. I before injection of papaverine. Thus, the arteriogenic impotence could not be excluded in patients of P. B. I. above 0.8. 2. Among the psychogenic impotences, there was no case of P. B. I. below 0.8 after injection of papaverine. So arteriogenic impotence could be like in the case of P. B. I. below 0.8. However, the arteriogenic impotence could not be excluded in the case of P. B. I. above 0.8 because 25(86.6%) patients of arteriogenic impotence were above 0.8. 3. The specificity. sensitivity and efficiency of the P. B. I. concerning prediction of response to papaverine injection were 88.2, 41.2, 80.4% in P. B. I. of 0.8. 4. The specificity, sensitivity and efficiency of the P. B. I. concerning prediction of findings of pudendal angiogram were 71.4, 90.3, 86.8% in P. B. I. of 0.9. In conclusion, it was difficult to establish the base line of normal value of P. B. I. and there was limitation of diagnostic value of the P.B.I.
Female
;
Humans
;
Impotence, Vasculogenic
;
Male
;
Papaverine
;
Reference Values
;
Sensitivity and Specificity
5.A Case of Hypervascularization of the Glans after Epigastrico-dorsal Vein Anastomosis.
In gyu CHOI ; Moon Mock OH ; Sae Chul KIM
Korean Journal of Urology 1988;29(2):335-339
We recently experienced a case of hypervascularization of the glans after arterialization of the deep dorsal vein(Furlow`s method) in a 25-year-old man having vasculogenic impotence due to arterial insufficiency of the penis. The Hypervascularization of the glans was corrected by ligating the branches of the deep dorsal Vein at the corona of the penis.
Adult
;
Female
;
Humans
;
Impotence, Vasculogenic
;
Male
;
Penis
;
Veins*
6.Current opinion in vasculogenic erectile dysfunction.
National Journal of Andrology 2002;8(6):438-441
Diagnosis of vasculogenic erectile dysfunction (ED), which can not based on single method, is the key for the successive surgical treatment. Revascularization is a safe, effective method to treat arteriogenic ED. The key for successive treatment is to select the most suitable patients and to avoid any risk factors for the surgical candidates, especially for those revascularization as the only therapeutic method. The high failure rate in surgery of ED is due to venous leakage which has led to these techniques being abandoned by almost all urologist. Newly appeared methods with little or no damage are welcome by the patients with vasculogenic ED, and the better results can be achieved by the combination of general treatment.
Humans
;
Impotence, Vasculogenic
;
diagnosis
;
surgery
;
Male
;
Practice Guidelines as Topic
7.Analysis of AVS- penogram in 3000 Impotent Patients.
Young Guy MINN ; Hyung Ki CHOI
Korean Journal of Urology 1994;35(9):1001-1006
Audio visual stimulation penogram(AVS-penogram) is used as a screening method for evaluation of erectile dysfunction. In this study, 3000 patients were evaluated from Dec. 1986 to Dec. 1992 and finally diagnosed by comprehensive diagnostic methods. The patients were classified according to AVS-penogram curves into 4 types and correlated with the patient's final diagnosis. For 800 patients who were evaluated with combined AVS penogram and NPT monitoring, compatibility ratios between psychogenic and organic group were compared. After correlating each of the curve type with the patients and comparing erotic and nocturnal erection, following results were obtained. 1. The mean age of the patients was 41.25 years. 2. The overall rate of final diagnosis were 57.5%, 14.3%, 8.9% in psychogenic, arteriogenic and venogenic impotence 3. Type I group was proved as psychogenic impotence in 87% of the patients. 4. Type II A group was proved as organic impotence in 79% of the patients and most of them had neurogenic and arteriogenic impotence. 5. Type II B group was proved as psychogenic impotence in 51%, organic impotence in 49% of the patients. Among the organic impotence group, most of them had arteriogenic, venogenic and neurogenic impotence. The difference of both group was statistically insignificant. 6. Type II C group was proved as psychogenic impotence in 39%, organic impotence in 61% of the patients. Further studies are needed for subclassification of both groups. 7. The compatibility ratio of the AVS-penogram and NPTM was 85.9% in psychogenic group with normal finding in both tests and 44.7% in organic group with abnormal finding in both tests. In conclusion, AVS-penogram is a primary diagnostic method in screening impotent patients and type I is regarded as psychogenic impotence. In Type IIB and IIC, subclassification of curve type is needed for differential diagnosis between psychogenic and organic impotence. Further studies are needed in more cases to obtain the objective analysis with compatibility ratio in combined AVS-penogram and nocturnal penile tumescence monitoring.
Diagnosis
;
Diagnosis, Differential
;
Erectile Dysfunction
;
Female
;
Humans
;
Impotence, Vasculogenic
;
Male
;
Mass Screening
;
Penile Erection
;
Photic Stimulation
8.Diagnostic Value of Penile-Digital Systolic Pressure index (PDI) in Arteriogenic lmpotence: A study for normal values in Korean males.
Korean Journal of Urology 1986;27(4):525-528
Penile and digital systolic pressures were measured with Doppler ultrasonic sthetoscope in 65 normal subjects. This technique is simple, reliable, inexpensive OPD procedure for the detection of penile arterial lesion in patients with impotence. With this study, we concluded that normal men have a PDI ratio above 0.77, and impotent men have a. PDI ratio below 0.63. However, the ratio range from 0.63 to 0.77 is borderline range which is not clearly impotent or normal. Hyperemic stress test is indicated the patient with borderline range. Pelvic steal test can detect vascular pathological condition previously missed by PDI. We indicate this test in the patients with history of intermittent gluteal claudication. We concluded that arteriogenic impotence is easily diagnosed by PDI combined with hyperemic stress test and pelvic steal test, if indicated.
Blood Pressure*
;
Erectile Dysfunction
;
Exercise Test
;
Female
;
Humans
;
Impotence, Vasculogenic
;
Male*
;
Reference Values*
;
Ultrasonics
9.Etiology of Erectile Dysfunction in Unmarried Men.
Seung Il JUNG ; Kwangsung PARK
Korean Journal of Andrology 2002;20(3):143-147
PURPOSE: We evaluated the contributing factors and etiology of erectile dysfunction (ED) in unmarried men. MATERIALS AND METHODS: From March 1998 to December 2001, we examined 49 unmarried men age 21 to 44 years (mean 29 years) with ED. All patients were assessed by history, physical examination, laboratory studies, combined intracavernous injection and stimulation test (CIS test), penile duplex ultrasonography, and other indicated tests to identify the etiology of erectile dysfunction. RESULTS: The majority of patients had vasculogenic impotence (arteriogenic 26.5%; venogenic 14.3%; mixed 16.3%). Less common were psychogenic (26.5%), hormonal (6.1%), neurogenic (8.1%), and other causes (2.0%). Contributing factors were present in 71.4% of patients, such as penile blunt trauma in 22 patients (44.9%), genitourinary disease in 14 (28.6%), substance abuse in 7 (14.3%), and medical illness in 5 (10.2%). CONCLUSIONS: Erectile dysfunction in unmarried men generally is vasculogenic in origin, and penile blunt trauma is the most common contributing factor.
Erectile Dysfunction*
;
Female
;
Humans
;
Impotence, Vasculogenic
;
Male
;
Physical Examination
;
Single Person*
;
Substance-Related Disorders
;
Ultrasonography
10.Clinical Application of Doppler Ultrasound in the Diagnosis of Vasculogenic Impotence.
Young Chan KIM ; Hyung Ki CHOI
Korean Journal of Urology 1984;25(1):1-5
The indirect measurement of arterial blood flow using Doppler Ultrasound was investigated to ascertain is significance and applicability in the diagnosis of impotence due to vascular insufficiency. The following results were obtained with a control group of 20 capable of normal erection and a group of 8 complaining of impotence with complete failure of erection. 1. the result of detection of the radial artery, dorsal and deep penile artery of the penis of the control group-the detection of the radial artery could be made with certainty whereas the dorsal and deep penile artery of the penis were difficult. since it varies with the individual. the ratio of frequency of the radial artery and the detectable penile artery was 1:0.779. 2. Of eight subjects with failure of erection due to trauma or spinal cord injury, one showing vascular insufficiency of the penis by pelvic angiography had a radial artery to penile artery ratio of 1:0.1, a typical finding in vascular insufficiency; whereas, in an another subject with urethral injury, the ratio was lowered to 1:0.3. In perspective, the limitation of the Doppler Ultrasound lies in the standardization equipment of and the technique of detection. However, in the investigation of impotence of vascular cause, Dopper Ultrasound should be the initial study because of its simplicity, safety and noninvasiveness. Further investigation is to be warranted.
Angiography
;
Arteries
;
Diagnosis*
;
Erectile Dysfunction
;
Female
;
Impotence, Vasculogenic*
;
Male
;
Penis
;
Radial Artery
;
Spinal Cord Injuries
;
Ultrasonography*