BACKGROUND: The precise pathophysiology of venous erectile dysfunction (VED) was still unclear. Dynamic infusion cavernosometry and cavernosography (DICC) was the gold standard approach for the diagnoses of VED. However, a standard operative procedure of DICC was needed and it was unclear whether DICC could show promise in accurate assessment and treatment of VED. The aim of this study was to establish an optimized operation process of DICC and evaluate the efficacy of DICC in the diagnoses and therapy of VED. METHODS: One hundred and forty-seven VED patients identified by the color doppler duplex ultrasonography (CDDU) were included. Then the method of DICC was adopted to assess the severity of VED and all patients were divided into 4 groups, including (1) non-VED; (2) mild VED; (3) moderate VED and (4) severe VED. All patients received the treatment of psychotherapy. Drug therapy, the intervention embolism of corpus cavernosum and the implantation of penile prosthesis were applied if psychotherapy was ineffective for patients. The international index of erectile function (IIEF-5) scores of patients were collected and compared before and after treatment. RESULTS: IIEF-5 score of non-VED group after psychotherapy (19.35 ± 3.59) and drug therapy (23.31 ± 0.75) was higher than that before psychotherapy (15.30 ± 2.72, t = -4.31, P < 0.01) and drug therapy (16.62 ± 1.50, t = -19.13, P < 0.01). IIEF-5 scores of mild VED (18.25 ± 2.60) and moderate VED group (14.83 ± 4.17) after treatment was improved significantly by intervention embolism of corpus cavernosum when compared with those before treatment (mild: 15.50 ± 2.14, t = -2.31, P < 0.05; moderate: 11.83 ± 2.86, t = -1.45, P < 0.05). However, drug therapy and intervention embolism (IE) of corpus cavernosum showed poor effects on patients with moderate and severe VED patients (P > 0.05). IIEF-5 score of severe VED group was increased under the treatment of implantation of penile prosthesis (23.25 ± 0.71) compared with that before treatment (8.00 ± 0.39, t = -53.25, P < 0.05). CONCLUSION DICC was a valid diagnostic tool that could identify patients with VED. And DICC had great effect on the diagnosis and individual therapy for patients with VED in varying degrees. Moreover, the manipulation of DICC needed uniform standards.
Adult ; Embolization, Therapeutic ; Humans ; Impotence, Vasculogenic ; diagnosis ; therapy ; Male ; Middle Aged ; Penis ; blood supply ; diagnostic imaging ; Ultrasonography, Doppler, Color ; Veins

OBJECTIVETo explore the procedures of dynamic infusion cavernosometry and cavernosography (DICC) and their application in the diagnosis and classification of venous erectile dysfunction (VED).

METHODSThis study included 103 ED patients, aged 20 to 43 years, highly suspected of VED, with disease courses of 4 months to 6 years. DICC was performed and analyses were made on the results, especially the parameters of flow-to-maintain (FTM) and pressure decay (PD) in the corpus cavernosum.

RESULTSBased on the parameters of FTM and PD, 21 of the patients were normal, 5 were suspected of VED, 39 had mild VED, 25 had moderate VED, and 13 had severe VED. Penile subcutaneous hematoma was found in 4 of the patients, all recovered after 3 to 5 days, with no other complications.

CONCLUSIONDICC is a reliable, safe and minimally invasive method for the diagnosis and classification of VED.

Diagnostic Techniques, Urological ; adverse effects ; Hematoma ; etiology ; Humans ; Impotence, Vasculogenic ; classification ; diagnosis ; Male ; Penile Diseases ; etiology ; Penis ; blood supply ; diagnostic imaging ; Radiography ; Veins

PURPOSE: The mean platelet volume (MPV) is a marker of the platelet activity and is reported to increase in vascular diseases. We aimed to investigate the association between MPV and vasculogenic erectile dysfunction (ED). MATERIALS AND METHODS: MPV and platelet (PLT) levels were measured in 50 cases of ED and 40 healthy controls. The diagnosis of vasculogenic ED was based on a detailed sexual history, physical examination, laboratory assessment, and color Doppler ultrasonography. The results are given as mean+/-standard deviation of the mean. RESULTS: The mean ages of the patient and the control groups were 53.70+/-12.39 years (range 24~77 years) and 53.85+/-9.5 years (range 30~73 years), respectively (p=0.947). The MPV and PLT values were significantly higher in the patients with ED than those of the controls (7.49+/-1.4), (6.85+/-1.2), (262.97+/-68), (252.89+/-82) respectively, p<0.001). However, the MPV values were not statistically significantly different in the patients with severe ED according to the International Index of Erectile Function than in those with mild ED, p>0.05), and there was no correlation between MPV and either age of patients (p=0.905) or duration of ED (p=0.583). CONCLUSIONS: The platelet count and MPV was detected to be increased in patients with vasculogenic ED. This finding suggests a role for platelets in the pathogenesis of vascular complications and that the MPV would be useful in monitoring disease progression.
Blood Platelets ; Diagnosis ; Disease Progression ; Erectile Dysfunction* ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Mean Platelet Volume* ; Physical Examination ; Platelet Count ; Risk Factors* ; Ultrasonography, Doppler, Color ; Vascular Diseases

OBJECTIVETo evaluate the 5-item version of the international index of erectile function (IIEF-5) as a method to differentiate the causes of vasculogenic erectile dysfunction (ED).

METHODSIn all, 103 ED patients (mean age 46.8 +/- 18.7) were reviewed by IIEF-5. Penile blood flow was also assessed in each patient after an intracavernosal injection (ICI) and audio-visual sex stimulation by duplex Doppler ultrasonography. The 99mTc-(113m)In dual radioisotope test was performed to confirm specific vascular causes in the vasculogenic ED cases. Kruskal-Wallis TEST was employed to compare the scores of IIEF-5 with the results of ICI, duplex Doppler ultrasonography and the 99mTC-(113m)In dual radioisotope test.

RESULTSOf the total number of ED cases, 37 (37/103, 35.9%) were nonvasculogenic, 18 (18/103, 17.5%) arteriogenic, 35 (35/103, 34.0%) venogenic and 13 (13/103, 12.6%) combined vasculogenic. There was no significant difference in the IIEF-5 scores either between the vasculogenic group and the non-vasculogenic one (P = 0.253) or among different groups of the vasculogenic ED patients.

CONCLUSIONIIEF-5 cannot be used as a tool for differential diagnosis of vasculogenic ED, or to compare its specific vascular causes, nor can the scores of IIEF-5 reflect penile vascular conditions.

Adult ; Humans ; Impotence, Vasculogenic ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Penis ; diagnostic imaging ; Smoking ; Surveys and Questionnaires ; Ultrasonography

OBJECTIVE: To study nomal valuels of PI, RI and S/D in healthy male penile dorsum artery (DA) and cavernosal artery (CA). METHODS: 257 healthy mature men were divided into 5 groups by age. Group 1: <30, n=65; Group 2: 30-39, n=83; Group 3: 40-49, n=61; Group 4: 50-59, n=38; Group 5: > or = 60, n=10. Hibateral PI, RI and S/D values of penile dorsum artery and cavernosal artery were examined by Logidop(r)2 Type Digital Doppler Ultrasonography. RESULTS: There were no significant difference for PI, RI and S/D of penile dorsum artery and cavernosal artery not only in personal left and right artery but also in different age groups. Normal values advised: (1)LDA:PI 1.43-3.43, RI 0.72-0.92, S/D 2.68-10.56. (2)RDA PI 1.47-3.47, RI 0.73-0.93, S/D 3.27-10.09. (3)LCA:PI 1.49-3.21, RI 0.74-0.90, S/D 3.17-9.55. (4)RCA:PI 1.93-3.27, RI 0.72-0.90, S/D 3.22-9.42. CONCLUSION Doppler ultrasonography is a favorable method in filtering penile arterial function.
Adult ; Age Factors ; Arteries/diagnostic imaging* ; Blood Flow Velocity ; Blood Pressure ; Humans ; Impotence, Vasculogenic/diagnosis* ; Male ; Middle Aged ; Penis/diagnostic imaging* ; Ultrasonography, Doppler

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

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

PURPOSE: Intracavernosal injection subsequent vibrotactile or audiovisual sexual stimulation (AVSS) have frequently been utilized to produce al maximal erectile response during penile Doppler ultrasonography. However, several studies have shown that erectile quality often decreases following the placement of the sonographic probe. We examined whether real-time AVSS with an eyeglasses-type monitor enhances quality during penile duplex color Doppler ultrasonography. PATIENTS AND METHODS: A total of 32 impotent patients underwent penile duplex color Doppler ultrasonography of the cavernosal arteries after intracavernosal injection of 10 to 20 microgram of prostaglandin E1 and subsequent manual stimulation. Real-time AVSS sas used when the patient failed to achieve a rigid erection or showed abnomal arterial blood flow. The clinical erectile response was assessed by visual inspection and palpation and graded from I to V. Peak blood flow velocities and resistance index of the both cavernosal arteries were monitored continuously. After AVSS, the sexual drive was assessed as grade I (poor), II (moderate), or III (good). RESULTS: After intracavernosal injection and genital stimulation, 3 patients (9%) had a Grade II erection, 2 (6%) a Grade III, 16 (50%) a Grade IV, and 11 (34%) a Grade V. During duplex ultrasonography, 4 patients (13%) had a Grade II erection, 7 (22%) a Grade III, 16 (50%) a Grade IV, and 5 (16%) an arade V. During real-time AVSS, 22 patients (69%) showed better drectile quality. Initial Doppler ultrasonographic scanning showed arteriogenic impotence in 9 patients (28%), veno-occlusive disease in 5 (16%), and mixed arteriogenic and venogenic impotence in 18 (25%), veno-occlusive in 9 (28%), and mixed type in 2 (6%). Therefore, the initial diagnosis turned to be different after AVSS in 26 patients (81%). The sexual drive was rated grade I in 9 (28%), grade II in 11(34%), and grade III in 12 (38%). CONCLUSION: Real-time AVSS with an eyeglasses-type monitor remarkably enhances the quality of pharmacologically induced erections. Such stimulation may be useful during penile color Doppler ultrasonography to help in making the ccorrect diagnosis of the cause of erectile dysfunction.
Alprostadil ; Arteries ; Blood Flow Velocity ; Diagnosis ; Erectile Dysfunction ; Female ; Humans ; Impotence, Vasculogenic ; Male ; Palpation ; Ultrasonography ; Ultrasonography, Doppler ; Ultrasonography, Doppler, Color ; Ultrasonography, Doppler, Duplex*

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*

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*