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

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

Although several reference values of the cavernosal arterial flow velocity were reported for defining the normal vascular condition including good arterial inflow and corporal venoocclusive function, still we have some confusions and limitations to interpret the results because of lack of standardization of some various factors relating to performing duplex scanning. Here in, we evaluated the effect of cavernosal arterial location that is measured by Doppler spectrum on the values of blood flow velocity. 36 patients with suspecting vasculogenic impotence entered the study. Color duplex sonography was performed in all patients. We obtained velocity measurements at 3 to 8 min intervals in both cavernosal arteries for at least 20 min after injection of PGE1 10ug. The cavernosal artery peak systolic flow velocity (PSV) and end diastolic flow velocity (EDV) were measured at two portions. the base over the ascending portion of cavernosal artery( 'Proximal') and midshaft( 'Distal') of the penis in each session. We classified the patients based on the results of Proximal values of duplex parameters into normal(maximal PSV>30 cm/sec and minimal EDV<5cm/sec throughout the study; NL group: n=8), arterial insufficiency with or without venous incompetency(maximal PSV< 25cm/sec; AI group: n=l2) and venous incompetency without arterial insufficiency(maximal PSV>30cm/sec and minimal EDV>5cm/sec; VI group n= 16). When we compared PSV values between two portions of measurement in each group all the Distal PSV values were significantly lower than Proximal(p<0.06) in NL and VI group, but no statistical difference was noted in PSV values of AI group(p>0.05). If we considered only Distal values for patient grouping 63% of VI group and 50% of NL group had maximal PSV values less than 25cm/sec that would be reclassified into arterial insufficiency. On the other hand, resistance index(RI) values remained unchanged regardless of measurement location in all groups. With the above results we can conclude that there is an obvious difference of blood flow velocities between two portions of measurement(Proximal vs Distal) and Proximal value is more reliable than Distal when we diagnose with previously reported normal reference value (PSV>30-35cm/sec).
Alprostadil ; Arteries ; Blood Flow Velocity ; Erectile Dysfunction ; Female ; Hand ; Humans ; Impotence, Vasculogenic ; Male ; Penis ; Reference Values

We have effectively used AVS-Penogram as the primary diagnostic method for impotence. In this study, we classified the types of curve on AVS-Penogram in detail and evaluated the origin of each of the classified types for 308 patients who were finally diagnosed by comprehensive diagnostic methods. Also we divided the unstable type into the multi-peak type and the one-peak type based on the number of peaks in the curve. and the delay type into the simple-delay type and the unstable-delay type based on whether there were fluctuations or not. After evaluating and considering the clinical significance of each of the curve type. we have reached the following conclusion. I. Type I group which is similar to normal control group was proved as psychogenic impotence in 86% of the patients. 2. The impossible type II A group was proved as organic impotence in 97% of the patients and most or them had neurogenic and arteriogenic impotence. 3. The unstable type II B group was proved as psychogenic impotence in 52% of the patients ;61% in the case of the multi-peak type, and 15% in the case of the one-peak type. The difference between both types were statistically significant. We think the one-peak type is more strongly related to organic cause, and in the case of the multi-peak type. further studies are needed for differential diagnosis between psychogenic and vasculogenic impotence, which were the most frequent types. 4. The delay type II C group was proved as psychogenic impotence in 4l% of the patients; 44% in the case of the simple-delay type, and 39% in the case of the unstable-delay type. There was no significant difference between these two types. In the case of the delay type, further studies are needed for differential diagnosis between psychogenic and arteriogenic impotence, which were the most frequent types. In conclusion, AVS-Penogram is a useful method in measurement of natural erotic erection and a primary diagnostic method in impotence, and it is an important differential diagnostic parameter to divide the unstable type into the multi-peak type and the one-peak type. Also in the case of the patient classified as multi-peak type, if more studies about neurotransmitter can be done, diagnostic methods from these studies can be developed. and the objective analysis of nocturnal penile enlargement can be achieved. new organic factor will be found in the patients proved to be psychogenic impotence.
Diagnosis, Differential ; Erectile Dysfunction ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Neurotransmitter Agents

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*

The 2 venous pathways that assure drainage of the corpora cavernosa are the deep dorsal and the perineal venous pathways. The deep dorsal vein have been investigated but the perineal pathway has received little attention. Recently, attention was focused on the prominent part of the perineal venous system in impotence. In our hospital during last 2 years, 12 consecutive impotent man who failed to achieve an erection after intracorporeal papaverine injection and revealed intact arterial system on Duplex-sonography underwent pharmacocavernosometry -cavernosography. Venous leakage was demonstrated in 12 patients : dorsal in 6, perineal in 4 and dorsal plus perineal leakage in 1. The perineal venous system consists of veins arising from the crural edge of both corpora and ligation of the crura penis seems to be efficient in the treatment of impotence owing to their leakage. We performed ligation of crura penis in two primary erectile impotence patients who was demonstrated perineal venous leakage on cine-cavernosography. Follow-up was approximately 12 months. One patient reported marked improvement in penile rigidity at erection allowing satisfactory intercourse, but another no improvement. Obvious question is whether simple ligation of the veins draining the corpora will correct the impotence in a man with a venous leakage. Therefore further studies on etiologic factors in venous leakage must be performed before definite treatment can be made.
Drainage ; Erectile Dysfunction* ; Female ; Follow-Up Studies ; Humans ; Impotence, Vasculogenic ; Ligation* ; Male ; Papaverine ; Penis* ; Veins

Cavernosography after injection of papaverine was done in 25 impotent patients who showed equivocal evidence for either psychogenic or organic erectile dysfunction and who were strongly suspicious of having vasculogenic impotence. Diagnostic value of the pharmacocavernosography was evaluated. Venous leakages through deep dorsal vein were noted in 13 patients, out of whom 3 patients showed leakage also via deep vein, abnormal cavernosal vein or cavernoso-glans fistula. All the arteriogenic and psychogenic, but 38.5% of the venogenic impotents, showed full erection at 30 seconds after infusion of contrast medium was begun. The response to injection of the papaverine was well correlated with findings of the cavernosogram in venogenic and psychogenic impotents. Therefore, the pharmacocavernosography is valuable in differential diagnosis of the venogenic and arteriogenic impotence as well as in diagnosis of the vasculogenic impotence.
Diagnosis ; Diagnosis, Differential ; Erectile Dysfunction* ; Female ; Fistula ; Humans ; Impotence, Vasculogenic ; Male ; Papaverine ; Veins

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

To evaluate the effect of time factor on the duplex flow measurements of the cavernosal artery we examined 30 patients with suspecting vasculogenic impotence by color flow duplex ultrasonographic evaluation. The cavernosal artery peak systolic flow velocity (PSV), end diastolic flow velocity ( EDV) and resistance index (RI) were determined bilaterally at preinjection, and 5, 10 and 15 min. following the intracavernosal injection(ICI) of PGEl(10ug) and phentolamine (0.2mg) mixture. We classified the patients based on the underlying vasculogenic status into normal (NL group; n=8), arteriogenic impotence with or without venogenic incompetency (AI group; n=11) and venogenic incompetency alone (VI group; n=11). The PSV in NL group was greatest at 5 min. postinjection (45.8+/-12.0cm/s) and declined significantly with time (30.0+/-5.8 cm/s) (p <0.06 ) and also significantly greater than the value obtained by the AI group at each time interval (p<0.01) with the greatest difference at 5 min. post injection. The EDV in NL group was low (0.75+/-0.96 cm/s) at preinjection and increased initially postinjection to 7.5+/-7.9 cm/s at 5 min. postinjection but then declined significantly (p<0.05). The EDV in VI group was significantly greater than that of NL at each time intervals (p<0.05) with the greatest value recorded at 10 min. post injection (l5.0 =5.5 cm/s). The RIs in all the group did not vary with time following ICI but that of NL was significantly lower than that of VI at each time intervals (p<0.01 ). Our data suggest that serial measurement of flow parameters, especially EDV as the indirect marker of veno-occlusive function, is necessary for the comprehensive understanding of hemodynamic vascular process of vasculogenic impotence since the duplex ultrasonographic flow parameters dynamically interact against time following ICI.
Arteries ; Erectile Dysfunction ; Female ; Hemodynamics ; Humans ; Impotence, Vasculogenic ; Male ; Phentolamine ; Time Factors ; Ultrasonography*

PURPOSE: To evaluate the usefulness of double injection of a vasoactive drug in penile Doppler ultrasonography for the diagnosis of vasculogenic impotence. MATERIALS AND METHODS: Eighty-four consecutive cases (bilateral sides) of 42 patients with suspected vasculogenic impotence were included in our study. We used computed sonography (Acuson, USA), with a 7 MHz linear array transducer. After the first intracavernosal injection of the vasoactive drug (10 ug of prostagladin E1), peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured three times. According to mean PSV and EDV, the patients were classified into four groups : arteriogenic impotence (AI;N=29), venogenic impotence (VI;N=28), AI associated with VI(N=14), and normal(N=13).After the second injection, PSV and EDV were remeasured, using the same method. Mean velocities of the first injection were compared with those of the second, and the paired t-test was used to analyze the results. the extent to which patients were reclassified after the scecond injection we noted. RESULTS: In all four groups, PSV measured after the second injection was significantly different from PSV after the first (p=0.0001, 0.0001, 0.0010, 0.0072); except in the normal group, EDV measured after the second injection was not different from EDV after the first (P=0.9815, 0.0654, 0.0950, 0.0057). After the second injection, the numbers of patients reclassified into other groups were as follows : AI, 11 (38%); VI, 6 (21%); AI associated with VI, 11 (79%); normal, 1 (8%). CONCLUSION: Double injection of a vasoactive drug affected PSV, and therefore, appears to be a useful adjunctive procedure for the evaluation of patients in whom classification based on the results of the first injection is difficult.
Classification ; Diagnosis ; Erectile Dysfunction ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Transducers ; Ultrasonography, Doppler*