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.     

New methods in the diagnosis of impotence: RigiScan® penile tumescence and rigidity monitoring and diagnostic papaverine hydrochloride injection

Summary In 26 patients with erectile impotence and 8 healthy volunteers the value of continuous monitoring of penile tumescence and rigidity by means of the RigiScan was tested. Based on history and routine screening tests the patients were divided into 3 groups of preliminary diagnosis: psychogenic (5 patients), organic (10 patients), mixed (11 patients). Real-time measurements of tumescence and rigidity were performed during direct visual stimulation and after intracorporeal injection of 80 mg papaverine hydrochloride according to a specific protocol. A total of 21 patients were monitored during sleep studies for 2 or 3 consecutive nights. The rigidity figures of the volunteers correlated well with their subjective interpretation of the erection. Evaluation of the recordings of the impotent patients enabled reclassification of the mixed group into 3 patients with mainly organic and 8 patients with mainly psychogenic impotence. RigiScan recording of penile tumescence and rigidity appears to be of great value in the diagnosis of impotent patients. Real-time monitoring during direct visual stimulation and after papaverine injection can generally replace nocturnal measurements. If the patient shows a positive response on visual sexual stimulation (VSS) alone, then his impotence is of psychogenic origin. Failing rigidity during VSS after injection indicates vascular impotence. In patients who show negative results during VSS alone, and positive response after injection or during subsequent VSS, nocturnal monitoring will differentiate between psychogenic and neurogenic impotence.     

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.     

Snap-gauge compared to a full nocturnal penile tumescence study for evaluation of patients with erectile impotence

A total of 50 consecutive male patients underwent simultaneous Snap-Gauge and full nocturnal penile tumescence evaluation with objective rigidity measurements to determine the correlation between the 2 studies. Subsequent clinical evaluation was conducted in patients in whom the 2 tests differed regarding diagnoses to determine which test more accurately predicted the clinical outcome. One patient was excluded from the study for technical reasons. Of 14 patients who had a normal Snap-Gauge evaluation, defined by breakage of all 3 bands, 12 (86%) had a normal and 2 (14%) had an abnormal nocturnal penile tumescence evaluation. A total of 28 patients failed to break any of the Snap-Gauge bands and 7 broke only 1 or 2 bands. Of these 35 patients with an abnormal Snap-Gauge study 14 (40%) had a normal and 21 (60%) had an abnormal nocturnal penile tumescence evaluation. In a subsequent clinical evaluation 1 of the 2 patients with a normal Snap-Gauge study and an abnormal nocturnal penile tumescence test reported continued inadequate sexual function and, subsequently, he received a penile prosthesis. Of the 14 patients with an abnormal Snap-Gauge study and a normal nocturnal penile tumescence test 11 were located and 8 were sexually active with adequate erections for intercourse without further medical treatment other than counseling. We conclude that the correlation between Snap-Gauge and nocturnal penile tumescence is not good, and that the nocturnal penile tumescence test is more accurate to determine the clinical diagnosis.     

Analyses of factors contributing to the erectile dysfunction with aging by nocturnal penile tumescence, penile blood pressure index and papaverine test

To evaluate the factors contributing to the decline in erectile function with age, we performed measurement of nocturnal penile tumescence (NPT) and penile vascular examinations in 407 men. The following results were obtained. 1) The penile circumferential increment during NPT measured by an erectometer was gradually decreased with age, especially markedly after 60 years of age. The percentage of subjects in whom the NPT was less than 10 mm increased with age: 2.7% in the 5th decade, 7.1% in the 6th decade, 16.7% in the 7th decade and 29.1% in the 8th decade. These findings indicate that the incidence of organic erectile dysfunction increased with age. 2) To evaluate the penile vascular status, measurement of penile blood pressure index (PBPI) and papaverine test were performed. The mean PBPI values were significantly decreased in the subjects over 70 years of age. The percentage of subjects having good response to papaverine injection obviously decreased with age: 66.7% between 50 to 59 years, 48.6% between 60 to 69 years, and 15.8% of over 70 years. All subjects in whom the NPT was less than 10 mm showed either a low PBPI level of less than 0.6 or an incomplete response to papaverine injection. These results suggest that penile vascular impairment plays a major role in the age-associated decline in erectile function. 3) We investigated the relationship between cigarette smoking and penile vascular impairment. Smokers showed not only lower PBPI values but higher incidence of the incomplete response to papaverine injection than nonsmokers. Therefore, it is considered that cigarette smoking is a significant risk factor in the erectile dysfunction that occurred in the aged.     

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.     

Unreliability of nocturnal penile tumescence recording and mmpi profiles in assessment of impotence

The authors describe a multidisciplinary approach to the assessment of impotence that includes the recording of nocturnal penile tumescence and analysis of the patient's MMPI profile. Ten patients were studied who, on the basis of physical and psychiatric assessment, were identified as being organically or psychogenically impotent. In each case, the application of decision rules based on either nocturnal penile tumescence or the MMPI would have led to misdiagnosis.     

Role of penile nocturnal tumescence and rigidity measurement in the diagnosis of erectile impotence.

Reviewing a group of 100 patients undergoing nocturnal penile tumescence and rigidity measurement (NPTR), we tried to define normal values and compared these results with those of other authors. We also tried to answer two important questions: Is an abnormal NPTR registration always a proof of biogenic impotence? Is a normal NPTR always a proof of psychogenic impotence?     

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.     

Diagnosis of vasculogenic impotence: combination of penile xenon-133 washout and papaverine tests

The present study evaluates both penile xenon-133 washout (XWT) and papaverine tests (PT) in the diagnosis of vasculogenic impotence. XWT was accomplished by subcutaneous injection of xenon-133 (1-2 mCi in 0.1 mL saline solution) into the dorsal coronal prepuce. Abnormal XWT was suggested in patients whose clearance time (T1/2) was longer than 7.5 minutes and whose penile blood flow rate (Q) was less than 6 mL/100 g tissue/min. PT was done by intracavernous injection of papaverine (60 mg in 20 mL normal saline). Abnormal PT was indicated in patients whose onset of full erection was more than ten minutes after papaverine injection and whose duration of erection was less than one hour. Ten young and 11 older normal volunteers were examined with XWT only; all showed normal results. A total of 60 impotent patients were examined with both XWT and PT and were classified into four groups: in 2 patients (3.3%) both XWT and PT were normal (group I); in 8 (13.3%) XWT was abnormal and PT normal (group II); in 14 (23.3%) XWT was normal and PT abnormal (group III); and in 36 (60%) both XWT and PT were abnormal (group IV). On further examination with bilateral hypogastric arteriography in 10 XWT-abnormal patients and on surgical correction of abnormal curvature in 5 XWT-abnormal patients, all (100%) were proved to have penile arterial insufficiency. Erection cavernosography performed in 15 PT-abnormal patients confirmed penile venous insufficiency in 80 percent. We conclude both XWT and PT are simple and effective for evaluation of the penile arterial blood flow and venous competence, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

The unreliability of nocturnal penile tumescence recording as an outcome measurement in the treatment of organic impotence

We investigated the degree of congruence between outcome measures used to evaluate pharmacological treatment of impotence. After a comprehensive multidisciplinary assessment 17 patients were treated with an adrenergic blocker during an 8-week interval. Nocturnal penile tumescence recordings were made before treatment (as part of the assessment procedure) and at its conclusion. As part of a larger study the use of nocturnal penile tumescence monitoring has been examined as a possible outcome measure. Patient and partner self-reports also were used to evaluate treatment outcome. A comparison of patient and partner self-reports with nocturnal penile tumescence records showed little agreement between the 2 measures. These findings suggest that despite its intuitive appeal as an index of erectile function nocturnal penile tumescence recording is not a reliable index of therapeutic effectiveness. Furthermore, these findings lend support to the hypothesis that nocturnal penile tumescence and sexual erections may be separate phenomena, perhaps under the control of different mechanisms.     

Effect of apomorphine on penile tumescence in men with psychogenic impotence

In a double-blind study using physiological recording of penile tumescence, brachial subcutaneous apomorphine hydrochloride injections elicited penile erections in men with psychogenic impotence. This observation is compatible with the hypothesis of central dopaminergic involvement in human penile erection. Since apomorphine is believed to induce erections by its effect on brain monoamine pathways, apomorphine response may have diagnostic use in evaluating the etiology of erectile failure.     

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.     

Comparison of nocturnal penile tumescence monitoring and cavernosal smooth muscle content in patients with erectile dysfunction

Purpose: Nocturnal penile tumescence monitoring was compared to cavernosal smooth muscle content in 48 cases of erectile dysfunction.Materials and methods: Pre-operatively nocturnal penile tumescence rigidity (NPTR) testing, colour Doppler sonography and if needed pharmaco cavernosometry-cavernosography were evaluated in 48 impotent patients before surgical intervention. The 40 patients whom all those diagnostic tools were abnormal constituted the first group. In the remaining 8 patients, which constitutes the second group, NPTR testing were normal but the other tests were abnormal. 10 potent patients with congenital penile curvature constituted the third group. Cavernous biopsies were obtained during the surgery and biopsies stained immunohistochemically to quantify smooth muscle cells (SMC) by anti-desmin and anti-SMA.Results: We observed statistical significant difference of corporeal SMC content with regard to first Vs second group and first Vs third group (p < 0.05). However we did not observe statistically significant difference with regard to second vs third group (p > 0.05).Conclusion: NPTR testing appears to correlate well with corporeal SMC, which is the key structures of erection. We think that with taking into the consideration of its specific reservations, NPTR testing is still one of the best non-invasive tool in the differential diagnosis of erectile dysfunction.     

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.