Role of confrontation in performance and interpretation of nocturnal penile tumescence studies

Nocturnal penile tumescence (NPT) studies were performed in 39 men complaining of erectile impotency. In over half the cases, the tracings alone without the results of monitoring did not allow conclusive determination of cause or suggest a reasonable treatment. Results of technician-monitoring of erections, and the patient's reaction to confrontation with the erections achieved, allowed a rational basis for treatment in most cases. NPT testing should be (1) monitored, and (2) used as an adjunct to planning treatment for, but not to determine cause of, erectile impotency.     

Penile calibration for nocturnal penile tumescence studies

Artificial penile erections were created in 23 impotent patients by infusion of heparinized saline solution into the corpora cavernosa. Penile circumference as related to rigidity was accurately assessed. The increase in circumference necessary to produce erection adequate for vaginal penetration varied from 7.5 to 35 mm, whereas for maximum rigidity the penile circumference increase varied between 10 mm and 40 mm. These were then compared with the changes during nocturnal penile tumescence studies. Even though 5 patients in the series had erection greater than 15 mm, 40 per cent of them did not achieve rigidity adequate for vaginal penetration. One patient had nocturnal tumescence of only 12 mm; this, however, was an erection adequate for vaginal penetration. The approach discussed in this article may allow the rational use of portable home tumescence monitoring.     

Prolonged nocturnal penile tumescence caused by epinastine

PURPOSE: We report a case of prolonged nocturnal penile tumescence (NPT) caused by the antiallergic agent epinastine. METHODS/RESULTS: We measured NPT using Rigiscan-Plus (DacoMed, Minneapolis, MN, USA) with or without the patient having taken epinastine. CONCLUSIONS: Considering its pharmacological effects on cyclic nucleotides, epinastine may have an effect on erectile function.     

Evaluation of nocturnal penile tumescence with potentest

PotenTest is a standardized, hygienically packaged, and reliable stamp test, useful for differentiating organic from psychogenic sexual dysfunction. Fifteen potent control patients wore a PotenTest band on three separate nights, and during a selfinduced erection, while PotenTest reliably induced nocturnal erections and penile rigidity. PotenTest and Snap-Gauge were used to evaluate pre- and postoperative potency in twelve cystectomy patients. The result with each test was essentially the same.     

曲唑酮对夜间勃起作用的初步探讨

目的：探讨曲唑酮对夜间勃起（NPT）的治疗作用，方法：对IIEF－5总分＜21分和NPT总时间＜30min的5例勃起功能障碍（ED）的患者，于睡前1h给予曲唑酮100mg口服，并分析用药前后的NPT曲线参数变化，结果：（1）NPT的幅度和时间在用药前后差异均有显著性意义。（2）3个勃起波形在用药前后各时间对比差异具有显著性意义。结论：曲唑酮可改善NPT，其作用机制可能是中枢性的。     

Reproducibility in monitoring nocturnal penile tumescence and rigidity.

The evaluation of sexual dysfunction has improved with the advent of methods to test nocturnal penile tumescence that also monitor penile rigidity. Earlier techniques may not have recorded abnormal rigidity despite normal tumescence. To test the reproducibility of penile tumescence and rigidity, the results of initial and repeat tracings performed a mean of 39 days apart were compared in 17 patients (median age 62 years). Three nocturnal patterns were identified. 1) Among the 17 patients the initial penile tumescence and rigidity pattern was reproduced on repeat testing in 15. 2) Patterns that were not reproduced in the other 2 patients were explained by the ingestion of alcohol or because of a febrile illness during the period monitored. 3) Nocturnal penile rigidity and tumescence tracings from these patients reproduced previous patterns. Monitoring of nocturnal penile tumescence and rigidity is a useful and reproducible tool in the evaluation of male sexual dysfunction.     

Avoiding false positive findings in measuring nocturnal penile tumescence

The measurement and interpretation of nocturnal penile tumescence (NPT) studies depend on appropriate measurement techniques, knowledge of the conditions during which NPT was recorded, and a lack of preconceived notions about the relationship of penile circumference to penile rigidity. This case report illustrates several of the most common problems in the measurement and interpretation of NPT that could result in a false positive finding.     

Analysis of nocturnal penile tumescence with continuous monitoring of penile rigidity

By continuous and simultaneous recording of nocturnal penile rigidity and circumferential expansion (tumescence), nocturnal penile rigidity and tumescence have been classified into 6 patterns: normal, dissociation, uncoupling, short episode, low amplitude and flat trace. The monitoring will be helpful to diagnose underlying disorders involving erectile impotence, if the pattern of nocturnal penile rigidity and tumescence are related with the disorders. This study analyzed the relationship between the pattern of nocturnal penile rigidity and tumescence and associated disorders in 105 patients with erectile impotence. Of 15 patients with central nervous system disorders, 9 (60%) had a pattern of short episode of rigidity. In 29 patients with cardiovascular disorders, the patterns of dissociation, low amplitude and flat trace were the main findings and observed in 41, 41, 35% of the group, respectively. No patients with diabetes mellitus showed normal pattern. Although the group of non insulin dependent diabetes mellitus (21 patients) had various patterns of rigidity and tumescence, the insulin dependent group (14 patients) mainly showed patterns of low amplitude (21%) and/or flat trace (71%). The continuous and simultaneous monitoring of penile rigidity and tumescence will be helpful, with an integral analysis of its pattern and other examinations, for accurate diagnosis of underlying disorders of organic impotence, besides for differentiation of organic impotence from psychogenic one.     

Importance of electromyographic data in interpreting nocturnal penile tumescence

The use of home monitoring of nocturnal penile tumescence has potential advantages if it can reliably replace full somnographic recording. However, little is known of the relationship between home monitoring and full somnographic recording. The present study compared 26 records from 13 patients. Each record was scored independently by two evaluators, and the results indicate that home monitoring can lead to overestimation of NPT and errors in etiologic diagnosis.     

夜间阴茎胀大试验在勃起功能障碍诊断中的应用

ED是一种常见的男科疾病,常由神经、血管或心理因素引起。其诊断方式多样。RigiScan阴茎硬度测量是以检测阴茎勃起为主的客观评估方法,近年来较为广泛的被临床所采用。本文综述了6项RigiScan检测参数(阴茎勃起次数、阴茎勃起总持续时间、阴茎头部和根部胀大硬度、阴茎头部和根部肿胀度以及周径胀大活力单位和硬度活力单位在ED诊断中的应用价值,以期为临床医师及科研人员应用夜间阴茎胀大试验(NPT)提供帮助。     

Comparison of results of nocturnal penile tumescence and rigidity in a sleep laboratory versus a portable home monitor

Objectives

To validate the results of the home penile tumescence monitor versus the sleep laboratory studies of erectile function.

Methods

We used both methods to study 18 episodes of rigidity and 19 episodes of tumescence in 10 subjects with erectile dysfunction before and after the use of an experimental vasodilating medication.

Results

The tumescence measurement in the sleep laboratory compared favorably with the changes in tumescence with the RigiScan portable home monitor: at the base (r=0.70; P<0.001 ) and at the tip (r=0.84; P<0.001). In measuring rigidity, the buckling pressure in the sleep laboratory compared favorably with the RigiScan measurements of percent average rigidity at the base (r=0.56; P=0.017), at the tip (r=0.62; P=0.006), and mean rigidity of the base and tip (r=0.64; P=0.004). In a comparison of the buckling pressure with the new RigiScan Plus quantitative program, there was good correlation with the rigidity activity units at the base (r=0.70; P=0.001 ) and at the tip (r=0.72; P<0.001 ). A clinical estimate of penetrable rigidity correlates with the RigiScan base rigidity of 55% to 60% and tip rigidity of about 50%.

Conclusions

The portable home monitor is a viable and cost-effective clinical tool to measure nocturnal penile activity.     

A new device for diagnostic screening of nocturnal penile tumescence

An erectometer for the measurement of sleep erections is described. Comparative studies using simultaneously strain gauges and the new device indicate that it possesses a significant potential for valid measurement of the circumferential increase that may occur during sleep. Because of its reliability, simplicity and low cost the erectometer is proposed as a screening procedure or as a diagnostic alternative when sleep laboratory facilities are not feasible.     

New method for continuous measurement of nocturnal penile tumescence and rigidity

A new technique for continuous recording of penile rigidity and tumescence has been developed. This methodology has been utilized in initial studies to define erectile function in both normal and impotent males. Accurate recording of tumescence and rigidity have been utilized to document the decline in erectile function associated with organic impotence.     

夜间阴茎勃起测定在性功能障碍诊断中的应用

对自诉有性功能障碍的患者１２０例，进行夜间阴茎勃起（ＮＰＴ）测定。结果：１２０例中精神性阳萎４７例，占３９．２％；器质性阳萎７３例，占６０．８％。认为，通过ＮＰＴ测定作为阳萎患者的初步筛选是有一定的临床价值。     

Clinical significance and usefulness of measuring nocturnal penile tumescence in children]

Nocturnal penile tumescence (NPT) is a physiological phenomena that is recognized in almost all normal males. This paper presents a study of NPT and the relation of this phenomenon to age, sexual maturation and physical growth in children. In 30 subjects, ranging from 3 to 18 years old, NPT was measured continuously throughout the night. The following results were obtained: 1. The frequency of NPT had a tendency to increase with age with a maximum frequency at 13 or 14 years of age, although the frequency ranged widely. 2. The maximum increase in penile circumference was below 10 mm in all cases below 10 years of age but was greater in children over 12 years old. 3. Tumescence time and percent tumescence time [tumescence time (min.)/sleep period time (min.)] x 100) was greater in children of over 12 years of age. Percent tumescence time showed a positive correlation with serum LH. Percent tumescence time was clearly higher in children with LH pulse, which indicates the onset of puberty, than in those without it. 4. These results suggest that NPT measurement in children can predict the onset of puberty, when coupled with endocrinological findings.     

多导睡眠仪监测下夜间阴茎勃起(NPT) 测定的应用价值

目的探讨多导睡眠仪监测下夜间阴茎勃起(NPT)测定在男性勃起功能障碍(ED)诊断中的作用及意义.方法我们将ED患者随机分成两组各60例、75例分别行多导睡眠仪监测下NPT和普通NPT检查,采用尼娃(NEVA)夜间阴茎勃起测定系统,以阴茎勃起幅度、勃起次数、勃起持续时间等作为评定指标.结果阴茎勃起幅度睡眠监测组为304.90±99.79,普通组为188.43±86.62,两组间存在显著差异(P＜0.01),两组的勃起次数、勃起持续时间也有差异(P＜0.05).结论多导睡眠仪监测下NPT测定具有准确掌握患者睡眠质量,检查数据误差小的优点,尤其对一些病情与诊断不符,怀疑普通NPT检查有假性结果的特殊病例,有较大的应用价值.     

Effect of low-intensity extracorporeal shockwave therapy on nocturnal penile tumescence and rigidity and penile haemodynamics

The study aims to evaluate the effect of low-intensity extracorporeal shockwave therapy (Li-ESWT) on nocturnal erection and penile haemodynamics. Patients with erectile dysfunction (ED) were enrolled from January 2018 to March 2019. Self-reported erectile symptoms, the International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Scores (EHS), nocturnal penile tumescence and rigidity (NPTR) and cavernous duplex Doppler ultrasound (CDDU) were evaluated. NPTR and CDDU were evaluated by Rigiscan and vascular ultrasound system respectively. Comparisons of NPTR and CDDU parameters were performed before and after Li-ESWT (Renova, once a week, 4 weeks in total). A total of 35 cases (mean age 36.51 ± 11.47 years) were enrolled for analysis. The IIEF-5 (10.60 ± 5.99 vs. 15.13 ± 6.22, p = .003), EHS (p = .016) and self-reported erectile hardness (p = .014) were significantly improved after 1-month treatment. Nocturnal erection frequency (p = .010), duration of total erection (p = .017), duration of erectile rigidity ≥60% at penile tip and base (p = .014 and p = .002) and the best erectile rigidity at penile tip and base (p = .012 and p = .005) improved significantly after treatment. However, no CDDU parameters improved after Li-ESWT (all p > .05). Li-ESWT can effectively improve subjective erectile function and nocturnal erection in ED patients. Large sample and well-designed studies need to be developed for supporting the current findings.     

Comparison of penile duplex ultrasonography with nocturnal penile tumescence monitoring for the evaluation of erectile impotence

A total of 50 patients with erectile dysfunction underwent comprehensive evaluation, including vascular evaluation with penile duplex ultrasonography and papaverine injection, as well as nocturnal penile tumescence monitoring. The latter was performed in a sleep laboratory setting in all patients. The results of penile duplex ultrasonography with papaverine injection were classified as 18 patients with normal vascular findings, 22 with arterial insufficiency, 3 with the pelvic steal syndrome and 7 with isolated venous leakage. Of the patients 15 had normal ultrasonographic and nocturnal penile tumescence findings, 29 had abnormal ultrasonographic vascular and nocturnal penile tumescence findings, 3 had abnormal ultrasonographic vascular findings and normal nocturnal penile tumescence (including 1 with the pelvic steal syndrome as evidenced by penile brachial index) and 3 had normal ultrasonographic vascular findings and abnormal nocturnal penile tumescence (including 2 with neurogenic erectile dysfunction). Penile duplex ultrasonography with papaverine injection appears to be a useful objective method to evaluate vasculogenic impotence and to correlate favorably with nocturnal penile tumescence monitoring. It also may have a higher yield than nocturnal penile tumescence monitoring in patients with the pelvic steal syndrome. While nocturnal penile tumescence is impaired in patients with neurogenic impotence, penile duplex ultrasonography with papaverine injection reveals, as expected, normal findings in patients with neurogenic impotence and normal vascular systems.