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.     

Evaluation of vasculogenic erectile impotence using penile duplex ultrasonography

A total of 140 patients underwent penile vascular evaluation with intracavernous papaverine injection combined with duplex ultrasonography. Of these patients 8 were potent men who were evaluated for reasons other than erectile failure. These potent men were used as controls to obtain normal values. The remaining 132 patients had erectile impotence of various etiologies. Real-time imaging with high resolution, high frequency probes allowed for visualization of the cavernous arteries along the entire length in addition to accurate measurement of the diameter. Simultaneous selectively focused Doppler ultrasonography was used to measure the blood velocity and other vascular parameters in the cavernous and dorsal arteries. Comparison of measurements before and after papaverine injection allowed for objective interpretation of the injection results. The results were analyzed and compared to other data available on the same patients, such as history and physical examination, nocturnal penile tumescence, penile blood pressures, selective arteriography and dynamic cavernosography. In addition to the 8 potent men, there were 35 patients (27% of the impotent patients) whose vascular findings were normal. A total of 78 patients (59% of the impotent patients) had arterial insufficiency; a subgroup of 13 patients had the pelvic arterial steal syndrome. Dynamic cavernosography confirmed venous leak in all 19 patients (14% of the impotent patients) whose penile duplex ultrasonography suggested the possibility of a venous leak. Ten patients (7%) had prolonged erection after papaverine injection and they were managed without consequences. One patient had a small hematoma that resolved uneventfully. Penile duplex ultrasonography was a helpful and objective method to evaluate vasculogenic impotence.     

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.     

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?     

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.     

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.     

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.     

Diagnostic tests for impotence: a comparison of papaverine injection with the penile-brachial index and nocturnal penile tumescence monitoring

The diagnostic usefulness of nocturnal penile tumescence monitoring, penile-brachial index and intracorporeal injection of papaverine (60 mg. in 20 ml. normal saline) was compared in 43 impotent men. Intracorporeal pressure was measured with a pressure transducer. Based on turgidity, and the time of onset and duration of erection, we classified the impotence as psychogenic/neurogenic (normal vascular competence), mild or severe arteriogenic, or venogenic. The intracorporeal injection of papaverine was useful as a functional diagnostic test for impotence. The penile-brachial index, an indirect measurement of the flaccid penis, did not correlate well with the results of the papaverine test. A poor response to papaverine injection documents organic impotence and, under these circumstances, nocturnal penile tumescence monitoring is not necessary. We conclude that the intracorporeal injection of papaverine currently is the best screening technique for the differential diagnosis of vasculogenic impotence.     

Predictive value of patient history and correlation of nocturnal penile tumescence, colour duplex Doppler ultrasonography and dynamic cavernosometry and cavernosography in the evaluation of erectile dysfunction

AIMS: The results of history and physical examination, nocturnal penile tumescence testing (NPT), colour flow duplex Doppler ultrasonography and dynamic infusion cavernosometry and cavernosography (DICC) were retrospectively correlated in 207 patients with erectile dysfunction. METHODS AND MATERIALS: The predictive value of the patient's own subjective assessment of early morning and nocturnal erections, history of cigarette smoking, the presence of vascular risk factors was correlated to the outcome of investigations. The result of Rigiscan NPT was correlated to the peak systolic velocity (PSV) and the resistance index (RI) determined at colour flow duplex Doppler ultrasonography, and the maintenance flow rate (Qm) determined at DICC. RESULTS: Eighty-five out of two hundred and seven patients (41%) had normal NPT comprising 48 out of 85 patients (56%) who described rigid early morning and nocturnal erections, 15 out of 85 patients (18%) who smoked cigarettes and 9 out of 85 patients (11%) with other positive vascular risk factors. 72 out of 85 patients (85%) had a normal PSV (>30 cm/s), 80 out of 85 patients (94%) had a normal RI (>0.85) and 82 out of 85 patients (96%) had a normal Qm), (<10 ml/min). Vascular investigations in this group identified 71 out of 85 patients (84%) with no penile vascular disease, 11 out of 85 patients (13%) with arteriogenic impotence, 2 out of 85 patients (2%) with mixed vasculogenic impotence and 1 out of 85 patients (1%) with cavernosal venous leakage (CVL). One hundred and twenty-two out of two hundred and seven patients (59%) had an abnormal NPT comprising 18 out of 122 patients (15%) who continued to experience rigid early morning erections, 65 out of 122 patients (53%) who smoked cigarettes, 59 out of 112 patients (48%) with other positive vascular risk factors, 36 out of 112 patients (29%) had an abnormal PSV (<30 cm/s), 49 out of 122 patients (40%) had an abnormal RI (<0.85) and 55 out of 122 patients (45%) had an abnormal Qm (>10 ml/min). Vascular investigations in this group identified five patients with no penile vascular disease, 51 out of 122 patients (41%) with arteriogenic impotence, 31 out of 122 patients (25%) with cavernosal venous leakage (CVL) and 35 out of 122 patients (29%) with mixed vasculogenic impotence. CONCLUSIONS: (1) a history of cigarette smoking and positive vascular risk factors are good predictors of organic impotence whereas the patient's subjective assessment of his own early morning erections is unreliable; (2) normal NPT correlates well with normal PSV, RI and Qm but does not exclude organic impotence; (3) abnormal NPT correlates well with abnormal PSV, RI and Qm.     

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。     

Infusion pharmacocavernosometry and nocturnal penile tumescence findings in men with erectile dysfunction

Infusion pharmacocavernosometry and nocturnal penile tumescence findings were compared in 50 men with erectile dysfunction of either organic or psychogenic etiology. Of the men 29 had abnormal and 21 had normal nocturnal penile tumescence. Infusion pharmacocavernosometry parameters (equilibrium pressure, maintenance flow rate and 30-second pressure fall) were compared to nocturnal penile tumescence status (normal versus abnormal). When traditional normal values were used for infusion pharmacocavernosometry parameters poor correlation with nocturnal penile tumescence status was found. When new cutpoints for infusion pharmacocavernosometry parameters were chosen a stronger correlation was noted. This study suggests that when vasoactive drugs are injected intracavernously for diagnostic purposes, anxiety and/or the absence of sexual stimulation following the injection may prevent complete cavernous smooth muscle relaxation resulting in falsely abnormal values. Therefore, over reliance on infusion pharmacocavernosometry as a single test for evaluation and treatment decisions concerning erectile dysfunction should be avoided.     

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.     

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。     

Snap-Gauge band compared to RigiScan Plus in a nocturnal penile tumescence study for evaluation of erectile dysfunction

OBJECTIVE: The aim of this prospective study was to examine the ability of the Snap-Gauge band to differentiate organic from psychogenic erectile dysfunction (ED). PATIENTS AND METHODS: Nocturnal penile tumescence testing was performed on 12 patients using a Snap-Gauge band and RigiScan Plus. A total of 29 nightly examinations were evaluated. The results obtained with the two methods were compared. RESULTS: The average tumescence, average rigidity, tumescence activity units and rigidity activity units in the positive group (the group of cases in which one, two or three films of the Snap-Gauge band were broken) were each significantly greater than that in the negative group (the group of cases in which no film was broken). The Snap-Gauge band correctly diagnosed 90% of the patients with a sensitivity of 100% and specificity of 75% with respect to results obtained using the RigiScan Plus. CONCLUSIONS: The Snap-Gauge band is inexpensive compared to the RigiScan Plus and is relatively reliable. We conclude that the Snap-Gauge band can play a role in ED assessment and can function as a screening device in evaluation of ED.     

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.     

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.     

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.