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*

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

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

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

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

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*

Diagnostic value of the pressure difference (PDBC) between brachial artery systolic pressure (BASP) and cavernosal artery systolic occlusion pressure (CASOP) was comparatively analyzed with penile brachial index (PBI), cavernosal artery duplex ultrasonography (CADU) and selective internal pudendal arteriography in 60 cases (30 patients) with suggestive arteriogenic impotence. 1. When arteriogram set as a standard control. the specificity and sensitivity of PDBC were 58.8% 61.8%, those of CADU were 57.1%, 59.4% and those of PBI were 55.8%, 70.6%. 2. When PDBC set as a standard control, the specificity and sensitivity of internal pudendal arteriography were 43.5%, 75.0%, those of CADU were 34.8%, 67.9% and those of PBI were 34.3%. 68.8%. Those results suggest that PDBC is not significantly correlated with internal pudendal arteriogram and it has a limitation in evaluation of arteriogenic impotence. Thus, PDBC should be interpreted in comparison with PBI, CADU and/or arteriogram.
Angiography* ; Arteries* ; Blood Pressure ; Brachial Artery ; Female ; Impotence, Vasculogenic ; Male ; Sensitivity and Specificity ; Ultrasonography