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.