Continuous monitoring of penile rigidity and tumescence in Japanese without erectile dysfunction

Continuous monitoring of penile rigidity and tumescence has been proved to be of use for accurate diagnosis of erectile impotence, since it provides objective recording of penile rigidity as well as circumferential expansion. Prior to clinical use of this procedure in Japan, a study was performed to clarify normal features of nocturnal penile tumescence of Japanese and to ensure safety of this procedure. The subjects consisted of 16 normal volunteers, aged from 24 to 44 years. With fully informed consent of the volunteers, nocturnal penile rigidity and circumferential expansion were simultaneously measured for three consecutive nights by means of RigiScan at the base of the penis (base) and at about five millimeters proximal to the coronary sulcus (tip). The minimum circumference of the penis was 62.7 +/- 4.6 mm (mean +/- SD) at the tip and 65.4 +/- 9.3 mm at the base. The maximum circumference, which meant full erection in the normal volunteers, was 102.5 +/- 14.2 mm at the tip and 108.6 +/- 14.7 mm at the base. The mean duration of tumescence, i.e. circumference expansion more than 10 mm, was 23.0 +/- 6.9 minutes at the tip and 38.3 +/- 12.0 minutes at the base. The mean rate of episodes of circumference expansion more than 10 mm was 0.75 +/- 0.27 per hour at the tip and 0.70 +/- 0.26 per hour at the base. The maximum rigidity lasting more than 10 minutes was 82.9 +/- 10.1% at the tip and 85.4 +/- 8.4% at the base.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Diagnosis of penile erectile dysfunction: simultaneous recording of nocturnal penile rigidity and circumferential expansion]

This paper briefly reviews diagnostic examinations for penile erectile dysfunction and mainly refers to a newly developed ambulatory system of RigiScan which enables simultaneous recording of penile circumferential expansion and rigidity, introducing the latest values of variables of penile tumescence and rigidity in the Japanese without erectile dysfunction.     

Comparison of international index of erectile function with nocturnal penile tumescence and rigidity testing in evaluation of erectile dysfunction

We tried to compare the parameters of nocturnal penile tumescence and rigidity (NPTR) testing with erectile function (EF) domain score of International Index of Erectile Function (IIEF), which is used in diagnosis and determining the severity of erectile dysfunction (ED), and to assess the sufficiency of IIEF in the diagnosis of ED. A total of 90 men, mean age 46 years (24-75), presenting with ED to our clinic between January 2001 and March 2003 were included in the trial. All the men answered the standard IIEF (15 questions) forms and was divided into four groups as mild ED, moderate ED, severe ED and no ED according to the EF domain score that is obtained from 1st, 2nd, 3rd, 4th, 5th and 15th questions. Then NPTR testing with the RigiScan Plus monitoring device was performed for two consecutive nights on those men. The distribution of the six parameters of NPTR testing (number of erections, duration of erections, TAU base, RAU base, TAU tip, RAU tip) among the four groups and the correlation with IIEF-EF domain score were evaluated. Additionally, the distribution of the risk factors (diabetes mellitus, hypertension, atherosclerotic heart disease, dyslipidemia and smoking) was analyzed both among the four groups and in each group. According to IIEF-EF domain scores of 90 patients, 16 (18%) had severe ED, 21 (23%) moderate ED, 41 (46%) mild ED and 12 (13%) no ED. There was no statistically significant difference between the risk factors among the men in these groups (P > 0.05). When the IIEF-EF domain scores were compared with parameters of NPTR testing, no statistically significant difference was obtained among ED groups (mild, moderate, severe) (P > 0.05). However, we observed a statistically significant difference between three ED groups and no ED group (P < 0.05). If NPTR testing is considered as a gold standard test, sensitivity, specificity, positive predictive value and negative predictive value of IIEF-EF domain score in ED diagnosis are 100, 17.9, 29.4 and 100% respectively. In conclusion, we did not observe a clinical correlation between IIEF-EF domain scores and NPTR parameters in the whole population; however, we observed that if IIEF-EF domain scores were normal, NPTR parameters were also normal. In other words, we can say that if the initial IIEF-EF domain scores are normal, then we do not have to perform NPTR testing. This could be helpful to make a cost-effective diagnosis.     

男子勃起功能障碍患者阴茎微循环检测

为了探讨男子勃起功能障碍（ＥＤ）患者阴茎微循环特点。检测２６例勃起功能障碍患者的阴茎微循环,与１７例健康志愿者进行比较。结果表明：器质性ＥＤ患者阴茎头微血管密度（２７．１±５．２,对照组为４７．８±６．２）和异常微血管百分率（３２．１±３．４,对照组为１２．８±１．３）均明显异于对照组,Ｐ＜０．０１;心理性ＥＤ患者的这两项指标与对照组相比没有统计学差别（血管密度４７．２±６．８,对照组为４７．８±６．２;异常血管百分率１３．１±１．１,对照组为１２．８±１．３,Ｐ均＞０．０５）。结论：器质性ＥＤ患者的勃起功能障碍与阴茎头微循环改变有关,其临床意义有待深入研究,阴茎头微循环检测可用于器质性ＥＤ的辅助诊断。     

Association between International Index of Erectile Function and axial penile rigidity in patients with erectile dysfunction

We investigated the association between the International Index of Erectile Function (IIEF) and axial penile rigidity parameters in patients with erectile dysfunction (ED). A total of 516 male patients (491 patients with ED and 25 patients without ED) were assessed using IIEF. Patients were assessed for axial penile rigidity (APR) using a digital inflection rigidometer. Mean age+/-s.d. was 52.4+/-9.9 y. ED was mild in 11.4% of the patients, moderate in 40.1%, and severe in 48.5%. Regarding APR, the following was found: (1) no significant difference between patients who had a mild degree of ED and patients who had no ED (P>0.05); (2) a significant difference between patients with different degrees of ED (P<0.05 for each); (3) a significant association between overall presence of ED and low APR (P<0.05). IIEF score is associated with APR and can differentiate between patients with and without ED.     

Vardenafil increases penile rigidity and tumescence in men with erectile dysfunction after a single oral dose

OBJECTIVES: To evaluate the effect of two doses of vardenafil hydrochloride on penile rigidity and tumescence while determining the pharmacokinetics. METHODS: Twenty-one patients with erectile dysfunction completed three oral single-dose regimens (placebo, 20 and 40 mg vardenafil) in a randomized, placebo-controlled, 3-way cross-over study. Penile rigidity and tumescence were measured at the base and tip with a Rigiscan for up to 2 h after dosing. The period included three 20-min repeated episodes of visual sexual stimulation. Blood samples were taken periodically up to 24 h after dosing. RESULTS: After 20 and 40 mg vardenafil, the mean duration of >60% rigidity of the base of the penis was greater than after placebo by 42.9 min (95% Cl 29.3-56.4) and by 49.3 min (95% Cl 35.7-62.9), respectively (p<0.001), and greater than after placebo by 34.6 min (95% Cl 22.1-47.1) for both doses at the tip. Additionally, significantly greater rigidity activity units and tumescence activity units were found for both doses compared with placebo (p<0.001). The plasma concentrations of vardenafil increased rapidly, with a median t(max) of about 40 min and a mean t1/2 of 4.4-4.8 h. Relative bioavailability was slightly higher for the 40-mg dose than for the 20-mg dose. The treatments were well tolerated, although slightly more adverse events, primarily headache, flushing and nasal congestion, were seen with the 40-mg dose compared with placebo. CONCLUSION: The findings confirm that vardenafil was able to generate stronger erections of longer duration than placebo under conditions of visual sexual stimulation in patients with erectile dysfunction. The pharmacokinetic, pharmacodynamic and tolerability profiles support vardenafil hydrochloride as a strong candidate for further testing as a treatment for erectile dysfunction.     

Treatment of erectile dysfunction with a penile prosthesis

From 1973 to February 1989 a total of 309 patients with erectile dysfunction were treated with hydraulic penile prostheses. In 169 patients a hydraulic prosthesis type AMSIPP700 was implanted; with this prosthesis the primary success rate was 91.1%. As a result of technical improvements to the device the revision rate, initially 52.3% has fallen to 3.3%. Patient acceptance is better with hydraulic prostheses, which provide optimal simulation of the physiological processes of erection and detumescence, than with any other type of prosthesis.     

男子勃起功能障碍病人阴茎微循环检测

检测26例勃起功能障碍（ED）病人的阴茎微循环，与17例健康志愿者进行比较，器质性ED病人阴茎头微血管密度为271±5．2，健康者为47．8±6．2（P＜0．01）；异常微血管百分率则分别为32．1±3．4与12．8±1．3（P＜0．01）；心理性ED病人该两项指标与对照组相比没有统计学差异（血管密度47．2±6.8vs47．8±6．2．P＞0．05；异常血管百分率13．1±1．1vs12．8±1．3．P＞0．05）。以上结果揭示，阴茎头微循环障碍与ED病人的器质性改变有关，可用于器质性ED的辅助诊断。     

阴茎微循环检测在阳痿诊断中的价值

目的：探讨阴茎头微循环检测在阳痿诊断中的意义。方法：检测２２例勃起功能障碍病人的阴茎微循环,与１７例健康志愿者进行比较。结果：血管性阳痿病人阴茎头微血管密度（２６．８±６．３ｖｓ４７．８±６．２,Ｐ＜０．０１）和异常微血管百分率（３３．２±３．６ｖｓ１２．８±１．３,Ｐ＜０．０１）与对照组相比有显著性差异;心理性阳痿病人的两项指标（微血管密度４７．２±６．８ｖｓ４７．８±６．２,Ｐ＞０．０５;异常微血管百分率１３．１±１．１ｖｓ１２．８±１．３,Ｐ＞０．０５）与对照组相比没有统计学差异。结论：阴茎头微循环障碍与阳痿病人的器质性改变有关,阴茎头微循环检测可用于血管性阳痿的辅助诊断。     

阴茎勃起功能障碍诊断方法探讨

目的　探讨阴茎勃起功能障碍 (ED)的诊断方法。　方法　对 186例阴茎勃起功能障碍患者分别采取国际勃起功能评分 (IIEF 5 )、阴茎海绵体注射 (ICI)试验、血清性激素 (LH、T、PRL和E2 )测定、阴茎彩色双功能超声、阴茎海绵体造影及球海绵体肌反射潜伏时间等检查。　结果　有186、71、2 8、4 5、2 1和 17例患者分别接受了上述检查 ,诊断心理性ED 4 6例 ,动脉性ED 6例 ,静脉性ED 15例 ,内分泌性ED 3例 ,神经性ED 3例 ,混合性ED 10例 ,原因不明 10 3例。　结论　ED是高度个性化疾病 ,针对患者不同情况采取相应的诊断方法 ,有利于选择高效、经济、安全的治疗方法。     

Home monitoring of penile tumescence for erectile dysfunction. Initial experience.

A technique using nocturnal penile tumescence monitoring has been developed to gather objective data on an outpatient basis. Patients have readily accepted the procedure and have easily learned to operate the monitor. Data from this group of controls and subjects are consistent with previously published reports by others. Suggestions are made from possible further refinements in technique.     

Nocturnal penile tumescence and rigidity (NPTR) findings in spinal cord injured men with erectile dysfunction

This prospective study aimed at determining whether nocturnal penile tumescence and rigidity (NPTR) findings correlate to the neurologic disorders in spinal cord injured (SCI) patients suffering from erectile dysfunction (ED). A total of 25 acute SCI male patients with post-traumatic ED underwent neurological, electrophysiological and urodynamic examinations, respectively, as well as NPTR recordings. The mean value for rigidity (R), tumescence (T) and duration (D) during NTPR tests were 83.3%, 3.3 cm, 6.4 min in patients with a complete lesion above the sacral (S2-S4) spinal cord (n=10), 46.1%, 1.6 cm, 5.5 min in patients with a complete lesion involving the sacral metameres (n=5) and 89.8%, 3.8 cm, 29 min in patients with an incomplete suprasacral lesion (n=7). The differences among these groups were statistically significant (P<0.05). Patients with lesions involving both sacral and thoracolumbar spinal cord showed no erections (n=3). We found four NTPR patterns: (1) normal R and T, short D; (2) weak R and T, short D; (3) normal R, T and D; and (4) no erections, which can be assigned to different levels and completeness of spinal cord lesions. Nocturnal erections of normal quality need preservation of thoracolumbar and sacral neuronal control as well as partially intact connections of the spinal erection centres with brain areas responsible for sexual arousal.     

三件套膨胀型阴茎假体治疗勃起功能障碍15例报告

为探讨三件套膨胀型阴茎假体治疗勃起功能障碍的手术方法和疗效,我院自１９９６ 年１２ 月至１９９９ 年２月对年龄２４ ～７９ 岁（ 平均４７ 岁） 的１５ 例器质性勃起功能障碍进行手术治疗。其中１３ 例使用 Ｍ Ｅ Ｎ Ｔ Ｏ Ｒ ＡｌｐｈａⅠ,２ 例使用 Ａ Ｍ Ｓ７００ Ｃ Ｘ 三件套膨胀型假体。阴茎阴囊交界处阴囊正中缝切口,阴茎海绵体置入圆柱体,水泵放置在阴囊底部的两个睾丸间,水库放置耻骨后间隙。本组手术顺利,术后均无伤口感染和阴囊血肿发生。１５ 例病人随访１ ～３０ 月,平均１５ ．４ 月;除术后１ 月的病人外,复诊或电话采访病人及其性伙伴均感性生活满意。随访期间未出现阴茎海绵体破裂和圆柱体膨出,也无圆柱体漏液或机械功能障碍现象,假体勃起时阴茎硬度足够,外观较好。三件套膨胀型阴茎假体植入术是治疗器质性勃起功能障碍很有价值的方法。     

三件套可控性阴茎假体植入术治疗器质性勃起障碍

目的观察三件套可控性阴茎假体植入术治疗器质性阴茎勃起障碍(ED)的疗效、安全性及可靠性。方法我科自1999年3月~2003年10月起使用国产/进口可控性阴茎假体对7例器质性ED患者进行假体植入治疗,并对其进行随访观察。结果7例器质性ED假体植入患者术后1周内均有不同程度的阴茎疼痛,其中1例因长期焦虑症状和阴茎勃起疼痛取出假体;其余假体目前使用情况良好。结论可控性阴茎假体植入术治疗器质性ED有效、安全、疗效可靠。良好的医患沟通,严格掌握手术适应证,正确仔细术中操作,正确及时假体使用指导是手术成功有效的保证。     

Vardenafil increases penile rigidity and tumescence in erectile dysfunction patients: a RigiScan and pharmacokinetic study

The pharmacodynamic effect on penile rigidity and tumescence and the pharmacokinetic properties of single oral doses of 10 and 20 mg vardenafil, a new PDE5-inhibitor, were investigated in 21 erectile dysfunction patients. Patients were evaluated with RigiScan on three occasions in a randomized, placebo-controlled, double-blind crossover fashion, while receiving visual sexual stimulation. Relative to placebo, a single dose of 10 mg vardenafil led to a mean increase in the duration of >60% penile rigidity of 24.4 min (95% CI: 7.4 to 41.3) at the base and of 24.8 min (8.5 to 41.1) at the tip. For the 20-mg dose, the increase in duration of >60% penile rigidity relative to placebo was 37.2 min (20.2 to 54.1) at the base and 28.7 min (12.7 to 44.7) at the tip. Single doses of 10 and 20 mg vardenafil led to a rapid rise in the plasma concentrations of vardenafil, with a median t_max of 0.9 h and 0.7 h and a geometric mean C_max of 9.1 μg/l (geometric SD=1.63) and 20.9 μg/l (geometric SD=1.83), respectively. In the post-absorptive phase, the concentrations declined with an average terminal t_1/2 of 4.2 h (geometric SD=1.27) and 3.9 h (geometric SD=1.31). The systemic exposure of vardenafil expressed as AUC normalized for dose and body weight was dose-proportional (associated 90% CI: −4 to 30%) as well as C_max (associated 90% CI: −12 to 33%). The treatments were well tolerated. There was a small, clinically irrelevant reduction in blood pressure with a small compensatory rise in heart rate. There were no electrocardiographic effects or relevant changes of the safety laboratory screens. The observed pro-erectile properties, pharmacokinetic characteristics and safety profile make vardenafil a suitable candidate for further evaluation in the treatment of erectile dysfunction.     

非性交勃起在勃起功能障碍患者阴茎康复中的应用

勃起功能障碍(ED)是临床上常见的一种男科疾病,有研究显示40~70岁的男性ED患病率约52%,且日益趋向年轻化。目前认为,缺氧是ED的独立危险因素,其导致ED的机制复杂多样。近年来,阴茎康复理念备受重视,这一理念的引导实施是通过增加海绵体组织氧供,降低组织纤维化和凋亡以促进勃起功能恢复正常。而针对增加海绵体组织氧供的一些非性交勃起手段,如行为治疗、药物治疗、真空负压吸引装置治疗、海绵体内注射治疗等,可在一定程度上模拟男性正常自然性交勃起,帮助患者进行有效的阴茎康复锻炼。本文就目前非性交勃起治疗在阴茎康复中的应用作一论述。     

Evaluation of penile revascularization for erectile dysfunction: a 10-year follow-up

The objective of this study was to report long-term success rates for penile revascularization (PR) and investigate factors responsible for failures. During the past 10 y, data were obtained on 52 patients who underwent PR. Surgical technique was selected according to preoperative arteriographic findings. The mean age was 28.5 y and the mean follow-up was 70.8 months. Success was defined as satisfactory intercourse without additional therapy. Overall success was 48%. Patients under 28 y showed a 73% success rate vs 23% in the older ones (P=0.0003). Nonsmokers had a 57% success compared to 29% in smokers (P=0.05). The presence of venous leak and type of procedure had an insignificant impact on success (P=0.33 and 0.23 respectively). To conclude, this curative treatment option is limited to a selective population with vasculogenic erectile dysfunction. We found that the cure rate of this procedure is maintained and long-term follow-up shows good results, especially in the young nonsmokers.