Recording method of nocturnal penile tumescence to evaluate the efficacy of X-ray endovascular treatment of vasculogenic erectile dysfunction

Abstract

Background. The vasculogenic form of erectile dysfunction (ED) is the most widespread of all forms of ED. As a rule, young men in the initial stages of the disorder are not ready to accept phalloprosthetics, making it a relevant concern to search for alternative ways of their sexual rehabilitation, including X-ray endovascular surgery. No less relevant is further improvement of the quality assessment methods for erectile dysfunction both for diagnostic purposes and for determining of efficacy of the treatment provided.Aim. To assess the quality of erectile function by monitoring nocturnal penile tumescence (NPT) in patients after X-ray endovascular treatment of vasculogenic ED.Materials and methods. Over 560 patients with suspected vasculogenic erectile disorder have been examined since 2012,  with  X-ray  endovascular  treatment  provided  to  121  patients  with  confirmed  veno-occlusive  ED.  To  assess the quality of erectile function in patients, we monitored NPT using an Androscan MIT registrar from January 2022 to September 2023, in each case one month before and after the surgical treatment of vasculogenic ED. Included in the study were 40 patients who underwent surgery with us, aged 25 to 48 years old (34.3 ± 7.4 years on average) and having vasculogenic ED, including those with veno-occlusive erectile disorders (n = 33), arterial insufficiency of the cavernous bodies (n = 5), hemodynamic and clinical signs of arteriovenous ED in the subcompensation stage (n = 2). Data were compared on changes in the penile diameter and duration of rigidity during NPT, reflecting the main hemodynamic indicators of the penile blood flow.Results. In the compensated stage of ED, the increase in the penile diameter during NPT was 20–30 %, with duration of tumescence being 43.2 ± 20 min; in the subcompensated stage, 10–30 % and 23 ± 21 min respectively. One month after treatment, these indicators were 45 ± 15 % and 76.3 ± 21 min respectively. After surgery, all patients demonstrated a recovery of the erectile function, and the linear and angle-independent blood flow indicators tended to normalize. The data obtained from the monitoring of NPT helped identify a correlation between the linear blood flow indicators, their derivatives, as well as the time and character of penile rigidity during NPT, making it possible to differentiate the types of vasculogenic ED and the criteria for its clinical compensation.Conclusion. At present, the instrumental diagnostics of ED is limited to the Doppler sonography of the penile vessels, which does not consider the multifactorial nature of the causes of erectile disorders in men of various ages. Registration of NPT using a standalone device allowing to reconduct the examination and to record the results graphically as erectograms can be used for minimally invasive objectification to confirm the recovery of the erectile function in the event of compensated and subcompensated stages of vasculogenic ED. However, further research is required into vasculogenic erectile disorders and the capacities for their assessment using NPT monitoring.