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

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

No abstract available.
Diagnosis* ; Female ; Impotence, Vasculogenic* ; Male ; Ultrasonography, Doppler, Duplex*

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*

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

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

We experienced 11 cases of the vascular reconstructive surgeries for the vasculogenic impotence from Nov, l985 to Aug, l986. The results as follows: l. The age distribution was from 24 to 35 year old. 2. The arterial insufficiencies were 4 cases, the venous leak 5 cases and the venous leak combined with the arterial insufficiency 2 cases. 3. Epigastrico-dorsal anastomosis in 1 case and epigastrico-cavernosus anastomosis in 3 cases were performed for the arterial insufficiency, and vein ligation in 3 cases or arterialization of deep dorsal vein with inferior epigastric artery in 2 cases for the venous leak. And we performed implantation of the arterialized vein with inferior epigastric artery into corpus cavernosum in 1 case of the venous leak combined with the arterial insufficiency. 4. The overall success rate were good in 7 cases, fair in 2 cases and bad in 2 cases. This results imply that vascular reconstructive surgery is a valuable surgical method prior to penile prosthetic surgery in the vasculogenic impotent patients.
Adult ; Age Distribution ; Epigastric Arteries ; Female ; Humans ; Impotence, Vasculogenic* ; Ligation ; Male ; Veins

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*

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

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