Nocturnal Penile Tumescence Monitoring Research Articles

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

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.

Adam sensor: a novel nocturnal penile tumescence wearable device - technology overview & applications

We present a novel, low-cost interconnected wearable device, called ADAM sensor, that measures the Nocturnal Penile Tumescence (NPT) in male patients suffering from Erectile Dysfunction (ED) and the new clinical and research applications that emerge from this technology. Given the consistent, and autonomic nature of nocturnal erections, NPT testing and monitoring can be a valuable clinical and research tool in the diagnosis and progress monitoring of ED. Rigiscan, the device currently used to measure NPTs, is bulky, uncomfortable and disrupts sleep. It was developed 30 years ago and it's not compatible with modern IT hardware and is usually physician-owned and lent to patients overnight or testing is carried out in a sleep clinic, resulting in a very high cost. Consequently, NPT measurement is rarely performed anymore in clinical practice. This is a technical note presenting a novel NPT measuring sensor, which is a ring-like device that users wear around their penis and detects changes in penile tumescence throughout the night. The data is continuously transmitted via bluetooth to the user's mobile phone and analysed by a dedicated mobile app, which reports three key metrics i) Number of erection episodes; ii) Total erection time and iii) Tumescence Activity Units. The advantages of the device are that it is easy to use, does not disrupt users sleep, low cost and the data analysis is continuously improving since it is performed in the cloud. This allows each patient to have their own sensor and continuously monitor NPTs over an extended period of time thus creating new applications of NPT testing, both for research and clinical purposes. The ADAM sensor is a novel, low cost, easy to use and non-obstructing device that can re-establish NPT monitoring as a useful clinical and research tool. None

Adam sensor: a novel nocturnal penile tumescence wearable device - technology overview & applications

We present a novel, low-cost interconnected wearable device, called ADAM sensor, that measures the Nocturnal Penile Tumescence (NPT) in male patients suffering from Erectile Dysfunction (ED) and the new clinical and research applications that emerge from this technology. Given the consistent, and autonomic nature of nocturnal erections, NPT testing and monitoring can be a valuable clinical and research tool in the diagnosis and progress monitoring of ED. Rigiscan, the device currently used to measure NPTs, is bulky, uncomfortable and disrupts sleep. It was developed 30 years ago and it's not compatible with modern IT hardware and is usually physician-owned and lent to patients overnight or testing is carried out in a sleep clinic, resulting in a very high cost. Consequently, NPT measurement is rarely performed anymore in clinical practice. This is a technical note presenting a novel NPT measuring sensor, which is a ring-like device that users wear around their penis and detects changes in penile tumescence throughout the night. The data is continuously transmitted via bluetooth to the user's mobile phone and analysed by a dedicated mobile app, which reports three key metrics i) Number of erection episodes; ii) Total erection time and iii) Tumescence Activity Units. The advantages of the device are that it is easy to use, does not disrupt users sleep, low cost and the data analysis is continuously improving since it is performed in the cloud. This allows each patient to have their own sensor and continuously monitor NPTs over an extended period of time thus creating new applications of NPT testing, both for research and clinical purposes. The ADAM sensor is a novel, low cost, easy to use and non-obstructing device that can re-establish NPT monitoring as a useful clinical and research tool. None

Management of issues relating to marriage, mental illness, and Indian legislation.

Management of issues relating to marriage, mental illness, and Indian legislation.

Мониторинг ночных пенильных тумесценций у здоровых добровольцев регистратором пенильных тумесценций «Андроскан МИТ» для установления достоверных границ нормофизиологических значений параметров прибора в условиях многоцентрового исследования

AIM To evaluate the normal numerical and graphic values of nocturnal penile tumescence (NPT) test using Androscan MIT in healthy males in order to use the collected data as reference standard. MATERIALS AND METHODS NPT monitoring was carried out in 38 healthy male volunteers by fixing a sensor designed for 20 measurements on their penis. During the NPT test the following parameters were recorded: 1) total sleep time; 2) minimal penis diameter (PD) in the flaccid state recorded by the apparatus; 3) maximum PD during effective penile tumescence; 4) absolute PD increase during effective erections; 5) increase in PD in %; 6) the overall time of the rigid-erection phase; 7) the number of penile rigidity episodes; 8) the average duration of each effective erection; 9) the percentage of rigid erections during the whole monitoring period. RESULTS Based on the data collected by Androscan MIT, we have specified the numerical values which characterize normal physiological NPT indices in healthy male volunteers. The number of tests performed and similar inclusion criteria contribute to the objectiveness of the presented data. Normal sleep time was from 7.3 to 9.5 hours. Monitoring during sleeping reflected the upper and lower limits of the minimal PD value recorded by Androscan MIT, which was from 23.5 mm to 30.2 mm. The maximum PD increase during the most effective erection varied from 35.3 mm to 44.3 mm. Total PD increase was from 10.6 mm to 15.4 mm (from 35.6% to 59.2%). In all cases a significant difference in PD increase between flaccid state and effective erection during sleeping was seen. The number of penile rigidity episodes varied from 3 to 7 a night. The overall time of effective erections was from 62.3 to 206.7 minutes, while the minimum duration of a single erection episode was 16.4 minutes and the maximum duration reached 35.8 minutes. The ratio of effective NPT to the total sleep time (the percentage of penile rigidity episodes) varied from 11.9% to 41.3%. CONCLUSION Our results allowed to define reference qualitative and quantitative values of NPT in healthy male volunteers recorded by Androscan MIT which can be considered as normal and physiological and used for differential diagnostics of erectile dysfunction.

AB029. The clinical significance of RigiScan plus detection

Erectile dysfunction (ED) is a common disease in male outpatient service, the penis hardness testing of ED in the clinical diagnosis has important significance, past some detection methods, such as nocturnal penile tumescence monitoring (NPT) due to time-consuming is not easy in outpatient service and a vasodilator agent intervention tests such as color Doppler detection due to the injection of drugs in the penis is difficult for patients to accept. In 1965 night rapid eye movement sleep phase 3–5 times of penile erection phenomenon was first reported by Fisher, in 1970 the night monitoring instrument of penis erectile hardness is used for evaluation of male erectile function. In 1985 researchers reported the RigiScan plus software was used to record of nocturnal erection, 1994 this method was gradually improved and used in clinical application by Levine. Sol reported that after taking sildenafil the patient was given audio-visual stimulation to induce the penis erects, then the RigiScan plus was used to record erection hardness in 2006. Due to the complexity of the etiology of ED, for the evaluation of penile erectile function should also be in many ways any single check has its limitations, the drug combined with audio-visual sense stimulation induced penile erection hardness monitoring (AVSS + RigiScan plus) in newly diagnosed patients with erectile function has a certain significance. Compared with AVSS + RigiScan examination, NPT is more expensive, time-consuming, and cumbersome, and patients feel unwell. And AVSS + RigiScan is simple, effective, easy, cheap, and the diagnostic accuracy rate matching to NPT, it is suitable for routine examination of patients with newly diagnosed ED.

AB132. Nocturnal penile tumescence monitoring: what have we done and what should we do?

ObjectiveErectile dysfunction (ED) is a complex disorder caused by multiple etiologies. It has been categorized into psychogenic, organic and mixed. Nocturnal penile tumescence (NPT) is critical to differentiate the organic or psychogenic and to evaluate penile erectile function. This report reviews all NPT measurements published, and presents the characteristics of each method.MethodsWe retrospectively reviewed all available literature focusing on NPT monitoring through a systematic PubMed search using the keywords “nocturnal penile tumescence” and “erectile dysfunction”. The advantages and limitations of each NPT monitoring method were analyzed.ResultsTo date, mainly seven methods and their modifications have been reported for NPT measurement: sleep laboratory testing, the mercury strain gauge, the stamp test, the erectometer, the Snap gauge, the RigiScan and nocturnal electrobioimpedance volumetric assessment (NEVA). Compared to direct observation and measurement from sleep laboratory testing, the invention and development of NPT recorders have largely improved the convenience of use; however, a variety of limitations exist for each method.ConclusionsThough NPT measurements have experienced a long period of evolution and have their particular strengths, none of these measurements are regarded as the “golden standard”. In this review, we described the various types of NPT measurements, the quantitative parameters that they use for evaluating erectile quality and ED treatment effects, their utility in the etiologic diagnosis and differential diagnosis of ED, and the disadvantages associated with each. The ideal NPT test: (I) accurate and comprehensive; II) simple, wearable, convenient and less sleep interference; (III) inexpensive is desperately needed in clinic.

Nocturnal Penile Tumescence Monitoring with Stamps—Barry JM, Blank B, and Boileau M

In a search for a screening test that would permit to differentiate between psychogenic and organic erectile dysfunction, Barry et al. developed [1] a simple test which used stamps to monitor nocturnal penile tumescence (NPT).

Classic Citations: Nocturnal Erections, Differential Diagnosis of Impotence, and Diabetes I Karacan, FB Scott, PJ Salis, SL Attia, JC Ware, A Altinel, and RL Williams

K et al. published this landmark paper [1] in 1976 with the aim of proposing the monitoring of nocturnal penile erections as “the” tool that might remove the bias in the diagnosis of erectile dysfunction. In the Introduction authors stated that the diagnosis and treatment of impotence remained, at that time, “essentially an art, if not a myth,” because of a belief that impotence was only result of psychological disturbances. They wrote that nocturnal erections had been known for almost 30 years and in the last 10 years their group had concluded that the normality of nocturnal penile tumescence (NPT) was a reliable and objective indicator of the psychological or organic basis of erectile dysfunction (ED); an abnormal NPT indicated an organogenic ED, whereas a normal NPT lead to the diagnosis of psychogenic ED. The objective of the paper was to describe their first 100 patients and to present NPT data on patients with psychogenic and organogenic ED. Most of the patients had been referred for prosthesis implantation with Dr. Brantley Scott. NPT recording was part of an extensive “medical, neurological, endocrinological, psychiatric, and psychological evaluation” that the patient underwent before the surgery itself. For NPT recording patients usually spent three nights in the Sleep Disorder Center, where three electroencephalography channels, two eye movement channels, two penile circumference channels, and two perineal muscle activity channels were monitored continuously throughout each night. Penile circumference was monitored with mercury-filled strain gauges placed at the tip and at the base of the penis. On one evaluation night a patient was awakened during a typical erection the degree of the erectile response. The examiner tested at that moment the buckling tendency of the penis and photographed the erect penis. Based on the data on penile circumference change and rigidity, the patient’s NPT was classified as normal, borderline normal, abnormally diminished, or absent. From the sample of 100 patients, authors selected 11 patients with ED and diabetes who had exhibited absent or abnormal NPT and 11 patients with ED, age-matched with the first group, without known medical diseases and whose nocturnal erections were normal. They also selected for comparison 11 age-matched normal individuals who had undergone three consecutive nights of NPT monitoring. The diabetic patients had significantly less nocturnal erections and spent less time with full erections than other patients and normal control subjects. The maximum penile circumference change exhibited by diabetic patients was approximately one-fifth that of individuals of the other two groups. In the discussion, authors claimed that their study provided the first objective data on the organic impairment of erection of diabetic patients. They concluded that “NPT recording © 2009 International Society for Sexual Medicine

Risk Factors for Erectile Dysfunction in Patients with Urethral Strictures Secondary to Blunt Trauma

Erectile dysfunction (ED) is a well-known consequence of pelvic fracture, particularly in cases involving urethral injury. There are several risk factors that may be related to ED. However, no systemic approach is used to assess erectile function secondary to urethral trauma. To investigate ED associated with urethral injury secondary to pelvic fracture and perineal trauma. Forty patients with traumatic urethral strictures secondary to blunt traumatic impact episode to the pelvis or perineum were included in our study. Pelvic fractures and urethral strictures were categorized according to injury types and radiological findings. All patients underwent nocturnal penile tumescence (NPT) monitoring, dynamic color-duplex Doppler ultrasonography (D-CDDU) before surgery. NPT monitoring was conducted again after surgery. The events of NPT and D-CDDU were recorded. In all patients, 11 had organic ED demonstrated by NPT. Vascular pathology was identified in three of 11 patients (27%). The peak systolic velocity of cavernosal artery was lower in patients with pubic diastasis in comparison to those without diastasis (P < 0.05). Significant changes in penile length and circumference were noted in posterior urethral injury compared with anterior urethral injury during erection (P < 0.05). The erectile duration time has a similar statistical difference in two groups mentioned above. However, no significant difference could be observed in the end-to-end anatomosis procedure before and after surgery (P > 0.05). The pelvic fracture type, especially pubic diastasis, is a risk factor for ED following urethral injury. Location of the stricture is also a risk factor for subsequent erectile dysfunction.

CASE REPORT: Management of Honeymoon Impotence

ABSTRACT Introduction Honeymoon impotence can be defined as the failure to be successfully involved in sexual intercourse at the beginning of marriage, particularly in the first few nights. While its exact causes are not yet elucidated, many studies recognize this problem as related to performance anxiety. Aim The aim of this study was to report the outcome of management of patients with honeymoon impotence. Methods and Main Outcome Measures This study included 100 consecutive patients presenting to our department complaining of failed sexual intercourse since the beginning of their marriage. History taking, completion of the abridged form of the International Index of Erectile Function (IIEF-5) questionnaire, and combined intracavernous injection and stimulation and nocturnal penile tumescence monitoring were performed. Penile duplex was performed to elucidate vascular insufficiency. All psychogenic patients with erectile dysfunction (ED) were treated with sildenafil and sex therapy. All organic ED patients were treated either with sildenafil alone or combined therapy with either intracavernous prostaglandin E1 or vacuum constriction device. Results Seventy-four patients had psychogenic ED and 26 patients had vasculogenic ED. All psychogenic ED patients were treated successfully with sildenafil and sex therapy. Twenty-two patients with vasculogenic ED were treated successfully with sildenafil or combined therapy, while four patients needed venous surgery. Minimal side effects of all treatment modalities occurred throughout the study. Conclusions Management of honeymoon impotence requires profound diagnosis of its causative factors. Treating physicians in areas with high prevalence of this condition should be ready to manage this problem with vigilant systematic overture. A combined approach of sildenafil and sex therapy proved highly effective in treatment of honeymoon impotence of psychogenic origin; however, controlled studies are needed. Other patients showing functional erectile abnormalities should be treated accordingly.

Relationship between nocturnal penile tumescence parameters, International Index of Erectile Function symptom scores and sildenafil responses

To evaluate the correlation between International Index of Erectile Function (IIEF) questionnaire scores, nocturnal penile tumescence parameters and sildenafil response in patients with erectile dysfunction using a minimal investigations approach. A total of 97 patients without any risk factors for erectile dysfunction were included. After completing the IIEF questionnaire, nocturnal penile tumescence monitoring was performed in all patients for 1 or 2 nights. Subsequently, sildenafil was given at a dosage of 50 or 100 mg according to the response. The relationship between nocturnal penile tumescence results, the severity of erectile dysfunction according to the IIEF questionnaire and sildenafil response was evaluated using Pearson's chi2 test. Based on the questionnaire scores, 25 patients (25.8%) had mild, 44 (45.4%) had moderate and 28 (28.8%) had severe erectile dysfunction. Forty-four patients (45.4%) had normal and 53 (54.6%) had abnormal parameters after nocturnal penile tumescence recording. The sildenafil response was positive in 63 patients (64.9%) who were given 50 mg and in 26 (26.8%) who were given 100 mg. However, eight patients (8.2%) did not respond to sildenafil. While the severity of erectile dysfunction according to IIEF scores and the sildenafil response did not show any correlations with nocturnal penile tumescence results, there was a statistically significant relationship between sildenafil response and the severity of erectile dysfunction. Changing concepts in the evaluation of ED have resulted in the use of effective therapeutic applications consistent with the degree of symptoms of patients without the waste of time caused by performing expensive, invasive, ineffective and time-consuming diagnostic tests.

First case report of sleep-related painful erection in Japan

Sleep-related painful erection is characterized by complaints of recurrent awakening with penile pain during erections, typically occurring during rapid eye movement sleep, followed by severe insomnia. Here, a case of sleep-related painful erection monitoring with nocturnal penile tumescence, the first case report in Japan, is presented. A 66-year-old man without obesity complained of nocturnal penile erections for 4 years. Overnight polysomnography and nocturnal penile tumescence monitoring showed an apnea-hypopnea index of 20 events/h, poor sleep efficiency of 73% and nocturnal awakenings after the second and third rapid eye movement sleep episodes with good rigidity and erection of penis.

Nocturnal Penile Tumescence Is Diminished but Not Ablated in Postproctectomy Impotence

We aimed to assess objectively the integrity of the parasympathetic neural pathway that controls the inflow choke vessels to the corpora cavernosa in a group of male patients with postproctectomy erectile dysfunction. The study group was male patients with erectile dysfunction after proctectomy for rectal cancer and inflammatory bowel disease identified by sexual function questionnaire. The group underwent two consecutive nights of home nocturnal penile tumescence monitoring with the Nocturnal Electrobioimpedance Volumetric Assessment device. The control group was also monitored. It comprised preoperative potent patients with rectal cancer and inflammatory bowel disease who had not yet undergone a variety of surgical procedures. Demographics and nocturnal penile tumescence parameters were recorded, including number, duration, and percentage increase in penile volume of tumescent events. Thirty-four impotent study group and 28 potent control group patients underwent nocturnal penile tumescence monitoring. The groups were well matched for mean age (difference, 1.4 years; 95 percent confidence interval, -5.8 to 8.6 years) and proportion with rectal cancer (difference, 6 percent; 95 percent confidence interval, -1 to 13 percent). The number of nocturnal penile tumescent events was greater for the potent group than for the control group (mean rank, 40.4 vs. 24.2; P = 0.0004). There was no significant difference between the mean duration (difference, 2.6 minutes; mean rank, 27.9 vs. 34.4; P = 0.16) or the mean penile volume increase (difference, 5.4 percent increase; mean rank, 30.6 vs. 32.6; P = 0.66) for tumescent events between the study and control groups. Mean age was significantly higher in complete than in partial impotence (60.9 vs. 53.1 years; difference, 7.8 years; 95 percent confidence interval, 0.1 to 15.5 years). There was a nonsignificant trend to a lower mean number of tumescence events among sildenafil responders than among nonresponders (3.5 vs. 4.8 events; mean rank, 11.2 vs. 17.3; P = 0.14). Nocturnal penile tumescence activity is diminished but not ablated by the trauma of surgical dissection. This suggests that some of the cavernous nerves that govern inflow to the corpora cavernosa are intact after surgery and that the nerve lesion responsible for erectile dysfunction is partial, and it explains why the response to sildenafil in such patients is surprisingly high.

Penile scintigraphy with 99mTc-human immunoglobulin G: a novel method for distinguishing the unstable and stable phases of Peyronie's disease.

To investigate the value of penile scintigraphy using 99mTc-human immunoglobulin G (IgG) to differentiate the unstable (acute) and stable (chronic) phases of Peyronie's disease (PD). Thirty-two consecutive patients (25 with PD and seven without) were evaluated using a detailed sexual history, serum chemistry panel, colour Doppler ultrasonography during simultaneous intracavernosal injection of 50 mg papaverine and stimulation, and 99mTc-IgG scanning. When indicated, nocturnal penile tumescence monitoring, dynamic infusion cavernosometry, cavernosonography and cavernosal artery systolic occlusion pressure were measured. After administering 370 MBq of 99mTc-IgG, images were taken at 30 min, 1, 2, 3 and 4 h. The scans were considered positive if there was any focal accumulation of radiopharmaceutical consistent with PD plaque formation. Eleven of the 25 patients with PD (mean age 56 years, sd 8) were in the unstable phase, the remaining 14 being in the stable phase. There was a localized increase in 99mTc-IgG activity in 10 patients who had unstable PD. There was complete resolution of increased activity in two patients at 12 and 13 months of follow-up. Of the 14 patients in the stable phase, 12 (at > 1 year) showed neither increased nor decreased 99mTc-IgG activity. In the remaining two patients there was increased activity on the plaque side. There was no local increase in activity in the control group. Inflammatory reactions can develop at various intervals during the unstable phase of PD. Medical methods should be used during the unstable phase and surgery delayed until the stable phase of the disease begins. An objective method of differentiating between the phases is therefore important. Penile 99mTc-IgG imaging is a new diagnostic approach for confirming the unstable phase of PD.

WHAT NONRESPONSE TO INTRACAVERNOUS INJECTION REALLY INDICATES: A DETERMINATION BY QUANTITATIVE ANALYSIS

In addition to its usefulness as a therapeutic modality, intracavernous injection may also be done in a diagnostic capacity. While a good response to an intracavernous injection test rules out venous leakage, a failed erectile response to the test in the office setting may not be completely representative of the patient erectile state. We determined by quantitative analysis the likely significance of failure to respond to intracavernous injection testing. Patients evaluated with the standard erectile dysfunction assessment at our andrology clinic between 1996 and 1999 were included in analysis. All 122 patients who did not meet study exclusion criteria underwent a test dose of intracavernous injection with papaverine, phentolamine and prostaglandin E1. Regardless of the response or lack of response to the test the men then underwent nocturnal penile tumescence testing, penile blood flow study and re-dose pharmacocavernosography. Results of these adjunctive tests were compared to the outcome of a papaverine, phentolamine and prostaglandin E1 intracavernous injection test by quantitative analysis. A total of 87 patients failed to respond to the test dose. Average age of the nonresponders versus responders was 46.8 versus 33.8 years. The duration of erectile dysfunction in nonresponders versus responders was 31.0 versus 13.7 months. Poor intracavernous injection responders required an average of 1.9-fold greater induction flow and 6-fold greater maintenance flow than good responders. Receiver operator characteristics (ROC) curve analysis revealed that the best predictors of the intracavernous injection test response were erectile dysfunction duration (ROC 0.99), patient age (ROC 0.87), maintenance flow (ROC 0.86), pressure loss (ROC 0.83) and resistive index (ROC 0.82). The ROC area for peak systolic velocity was 0.69. Our results indicate that age and erectile dysfunction duration alone are the most important variables affecting the results of an intracavernous injection test. However, in patients older than 40 years with a greater than 2-year history of erectile dysfunction failure to respond to intracavernous injection testing is most closely associated with venous insufficiency, as evidenced by the high ROC values for variables indicative of venous insufficiency, namely maintenance flow, pressure loss and the resistive index. Therefore, nonresponse to an office intracavernous injection test in an older patient with erectile dysfunction of long duration is most likely due to venous leakage. If only 1 confirmatory test is possible, cavernosometry provides the most information.

Effect of radical retropubic prostatectomy on erectile function, evaluated before and after surgery using colour Doppler ultrasonography and nocturnal penile tumescence monitoring.

To assess the effect of radical retropubic prostatectomy on erectile function, by evaluating objectively patients' erectile function before and after surgery. The study comprised 126 patients with clinically localized prostate cancer who were scheduled to undergo radical retropubic prostatectomy. After giving informed consent for the study, 123 patients underwent intracavernosal injection tests, colour Doppler ultrasonography and nocturnal penile tumescence monitoring before and after surgery. From the intracavernosal injection tests and nocturnal penile tumescence monitoring, 21 patients (17%) were evaluated as having normal erectile function before surgery. After radical retropubic prostatectomy, nine (43%) of these 21 potent men had preserved erectile function. In eight patients whose neurovascular bundles were preserved, five were potent after surgery. The cause of erectile function after surgery was a neurogenic disorder in seven and a related vascular disorder in five. From objective tests of erectile function on patients scheduled to undergo radical prostatectomy, 17% had normal erectile function. However, even after nerve-sparing radical retropubic prostatectomy, the proportion retaining potency was unsatisfactory. Although a neurological disorder was the main cause of erectile dysfunction after surgery, vascular disorders were also important.

Male sexual function and its disorders: physiology, pathophysiology, clinical investigation, and treatment.

This review is designed to help the reproductive endocrinologist integrate his or her professional activity with those of other disciplines including urology, radiology, neurology, and psychology in order to successfully manage all of the inseparable aspects of male sexual and reproductive functioning. Significant advances in the field of male sexual physiology and pathophysiology and new methods of investigation and treatment of male sexual disorders are outlined. The review synthesizes available data on the following: norms of sexual organs, aging and sexuality, role of central and peripheral neurochemicals in each stage of the sexual cycle, role of corporeal smooth muscles in the hemodynamic control of erection and detumescence, influence of psychological factors, drugs, and disease on all aspects of sexual functioning, and use of nocturnal penile tumescence monitoring, imaging investigations, and neurophysiologic studies in the diagnostic workup of males with sexual dysfunction. Clinical algorithms are presented where appropriate. Extensive discussions on newly developed strategies in psychological and behavioral counseling, drug therapy, tissue engineering, nonsurgical devices, and surgical treatments for all forms of sexual disorders are also provided. Lastly, the effect of sexual dysfunction and its treatment on quality of life in affected men is addressed, along with recommendations for future research endeavors.

Male Sexual Function and Its Disorders: Physiology, Pathophysiology, Clinical Investigation, and Treatment

This review is designed to help the reproductive endocrinologist integrate his or her professional activity with those of other disciplines including urology, radiology, neurology, and psychology in order to successfully manage all of the inseparable aspects of male sexual and reproductive functioning. Significant advances in the field of male sexual physiology and pathophysiology and new methods of investigation and treatment of male sexual disorders are outlined. The review synthesizes available data on the following: norms of sexual organs, aging and sexuality, role of central and peripheral neurochemicals in each stage of the sexual cycle, role of corporeal smooth muscles in the hemodynamic control of erection and detumescence, influence of psychological factors, drugs, and disease on all aspects of sexual functioning, and use of nocturnal penile tumescence monitoring, imaging investigations, and neurophysiologic studies in the diagnostic workup of males with sexual dysfunction. Clinical algorithms are presented where appropriate. Extensive discussions on newly developed strategies in psychological and behavioral counseling, drug therapy, tissue engineering, nonsurgical devices, and surgical treatments for all forms of sexual disorders are also provided. Lastly, the effect of sexual dysfunction and its treatment on quality of life in affected men is addressed, along with recommendations for future research endeavors.

INTRACAVERNOSAL PHENYLEPHRINE FOR RECURRENT PRIAPISM: SELF-ADMINISTRATION BY DRUG DELIVERY IMPLANT

A 28-year-old white man presented with a 3-year history of painful, nocturnal, prolonged erections. These erections occurred every night and lasted from 1 to 6 hours. Medical history included circumcision. The patient did not take any medication, and physical examination was normal. The etiology of the prolonged erections was unknown in that all hematological evaluations were normal and Doppler ultrasound excluded an arteriovenous malformation. Nocturnal penile tumescence monitoring confirmed a prolonged erection lasting for 4 hours. Treatment with 2.5 mg. procyclidine 3 times daily1 was unsuccessful as was 100 mg. cyproterone acetate taken at night. The surgical implantation of a penile drug delivery system to delivery phenylephrine was offered to the patient.2 Through a lateral penoscrotal incision the Brindley‡ drug delivery implant was placed with the cannula inserted into the lateral aspect of the right corpus cavernosum and sutured to the tunica albuginea with a nonabsorbable suture (see figure). The combined pump/reservoir was filled with saline and positioned in a dependent position in the scrotum. The patient was discharged home the next day. At 1-month followup the saline solution in the reservoir was withdrawn and phenylephrine solution was instilled percutaneously. After an initial titration period, 50 mg. phenylephrine solution (10 mg./ml.) diluted with normal saline to a volume of 8 ml. was percutaneously instilled into the reservoir. The patient was instructed on how to squeeze the pump so that 1 squeeze delivered 0.13 ml. (0.8 mg.) phenylephrine solution into the corpus cavernosum. The patient used the device for 4 months and was successful in reversing the prolonged painful erections.