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

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

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

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*

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

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*

Recently, the priapism is mostly seen after intracavernous injection of vasoactive drugs for the diagnosis and therapy of erectile dysfunction. Prompt relief of the priapism is essential to prevent ischemia and fibrosis of the corpora with resultant impotence. Of 2992 patients who have used intracavernous injection of vasoactive agents for diagnostic and therapeutic purposes of erectile dysfunction (August 1986-June 1995), 133 men (4.4%) experienced priapism persisting for more than 4 hours. Mean patient age was 45.6 (23-70) years. The etiology of impotence was psychogenic in 60.2%, unclear in 16.5%, vasculogenic in 10.6%, diabetogenic in 8.3%. The vasoactive agents used for the intracavernous injection were: 1) papaverine, 2) dimix; a mixture of papaverine (27. 3mg/ml) and phentolamine (0.9mg/ml), 3) trimix; a mixture of papaverine (18.8mg/ml), phentolamine (0.5mg/ml) and PGE1 (6.3mg/ml). The incidence of priapism was 3.8% in papaverine, 7. 7% in dimix and 0.7% in trimix. The average doses of papaverine, dimix and trimix to have developed the priapism were 30.3+/-9.8mg, 0.4+/-0.3ml and 0.15+/-0.1ml, respectively. Average duration of the priapism was 8.6 (4-59) hours. Priapism usually developed during diagnostic workup (63.2%) and initial dose determination phase of treatment (32.3%). The priapism resolved spontaneously in 44.4%. The priapism was treated by aspiration alone in 17.3% and irrigation with 0.1% epinephrine solution in 37.6%. One patient required cavernosaphenous shunt operation. The potency became worse after resolution of the priapism in 5 among 34 patients of follow-up. The etiology of impotence in these 5 men was vasculogenic (1/3), psychogenic (2/22) and unclear (2/4). In conclusion, trimix is the best drug among the 3 regimens for the intracavernous self-injection in terms of lowest incidence of drug-induced priapism. Vasculogenic impotence patient seems to have a greater risk of worse potency after resolution of the priapism.
Alprostadil ; Diagnosis ; Epinephrine ; Erectile Dysfunction ; Female ; Fibrosis ; Follow-Up Studies ; Humans ; Impotence, Vasculogenic ; Incidence ; Ischemia ; Male ; Papaverine ; Phentolamine ; Priapism*