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

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*

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

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

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*

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*

Forty two patients including 1O cases of the normal control were studied with the radioisotope penogram. The causes of the impotence were arteriogenic in 1O cases, venogenic in 6, diabetes mellitus in 8, neurogenic in 2, endocrinogenic in 1 and psychogenic in 15, ranging from 19 to 70 years of age. Ten normal volunteers for the control group were ranged from 21 to 38 years of age. All were subjected to Snap-Gauge test and measurement of the penile blood pressure with estimation of the penile brachial index (P.B.I.). We calculated the Penogram Index in time-activity curve of the radioisotope penogram and studied the inter-relationship between the Penogram Index and the etiologic diseases, Snap-Gauge test, PBI. The results were obtained as follows; 1. Inter-relationship between the diseases and the penogram index, arterial index (Index A) and venous index (Index V1, V2); 1) Index A was 1.44 in normal control group, 0.55 in arteriogenic. 0.62 in venogenic, 0.64 in diabetes mellitus, 0.95 in neurogenic, l.29 in endocrinogenic and 1.03 in psychogenic impotence. This suggested that Index A was significantly correlative with state of the penile arterial inflow. 2) Index V1, V2 were 0.09, 90 in normal control group, 0.09, 51 in arteriogenic, 0.40, 29 in venogenic, O.8l, 38 in diabetes mellitus, 0.84, 90 in neurogenic, O.92, 34 in endocrinogenic, and 0.91, 64 in psychogenic impotence. This suggested that Index V1 and V2, particularly V1 was representative of maintenance of the penile blood flow and the penile venous outflow or leak. 2. Relation between Snap-Gauge test and Index A; Correlated in 77.8% of the patients and the normal controls, respectively. 3. Relation between P.B.I. and Index A; Correlative. 4. Relation between P.B.I and Index V1, V2; Not correlative Therefore, the radioisotope penogram was a very useful method in diagnosis of the organic impotence, particularly vasculogenic impotence to different late arteriogenic and venogenic.
Blood Pressure ; Diabetes Mellitus ; Diagnosis* ; Erectile Dysfunction* ; Female ; Healthy Volunteers ; Humans ; Impotence, Vasculogenic ; Male

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

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

For differential diagnosis of psychogenic from primary erectile dysfunction we investigated clinical spectrum of 110 unmarried impotent patients as a retrospective study ; Psychogenic impotent patients were 78 cases. and primary impotent patients were 9 cases. We concluded as follows; 1. 9 cases or primary impotent patients were all classified as abnormal group in AVS-Penogram. and 4 cases of venogenic or venogenic associated cases showed type IIB(unstable) subclassification. while psychogenic group showed abnormal classification in 66% (51/78). All or primary impotent group showed abnormal results of RigiScan especially with dissociation subclassification in 55.6% (5,9). meanwhile psychogenic group showed normal patterns in 92% (72,78). 2. The most common cause of primary erectile dysfunction was vasculogenic impotence, 88.9 %(8/9). Therefore. we can make confirmatory diagnosis of the rare primary erectile dysfunction in patients showing abnormalities in both nocturnal and erotic erection through full vascular studies.
Classification ; Diagnosis ; Diagnosis, Differential ; Erectile Dysfunction* ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Retrospective Studies ; Single Person