Nocturnal Penile Tumescence Testing Research Articles

An atypical erectile dysfunction patient with infertility treated with penile prosthesis implantation and testicular epididymal sperm aspiration (TESA)-intracytoplasmic sperm injection (ICSI): A case report.

Erectile dysfunction (ED) is common in middle-aged and elderly men, affecting more than 100 million males worldwide. Most ED cases can be attributed to organic and/or psychological factors. Here we report an atypical ED case with no clear manifestation fitting the diagnosis for recognized types of ED. The 35-year-old male is unable to have normal erection since puberty, and unable to complete intercourse with his wife. He had no history of trauma, surgery or psychiatric/psychological disease. The patient has a normal male karyotype. There is no significant finding in physical examination, nocturnal penile tumescence test, and ultrasound measurement of penis vascular functions. The serum levels of major hormones are all in normal ranges. Atypical ED, psychogenic ED not excluded; infertility. Oral phosphodiesterase inhibitors Tadalafil (20 mg, BIW) or Sildenafil (50 mg, BIW) had no effect in this patient. Penile prosthesis implantation helped the patient to acquire normal sexual life, but did solve the ejaculation failure and infertility. Motile sperms were obtained by testicular epididymal sperm aspiration under the guidance of ultrasound, and intracytoplasmic sperm injection was performed with occytes retrieved from his wife. The patient sexual life was significantly improved after penile prosthesis implantation; the patient wife is currently in the first trimester of pregnancy as the result of in vitro fertilization. The no response to phosphodiesterase type 5 inhibitors (PDE5) treatment may suggest an impediment of PDE5-related pharmacological pathways or the presence of defect/injury in the neural system. This special case raises a question if some patients with persistent ED may have similar manifestations and can be treated with the same procedures.

(357) Nocturnal Penile Tumescence Test in Patients with Erectile Dysfunction Associates With Penile and Systemic Vascular Disease

Abstract Introduction Erectile dysfunction (ED) is the most frequent male sexual dysfunction along with premature ejaculation. Moreover, its prevalence is increasing worldwide due to ageing of the population and spreading of risk factors like obesity, diabetes, hypercholesterolemia, hypertension, etc. Also, it represents an important cardiovascular risk marker because of its demonstrated tight association with cardiovascular disease (CVD). We dispose of many diagnostic tools to assess ED and a proper workup includes the anamnesis, a physical exploration, blood tests for hormonal and metabolic evaluation, and ED grading through validated questionnaires such as the International Index of Erectile Function (IIEF). One of the instrumental tests we may indicate is the nocturnal penile tumescence (NPT) test or “Rigiscan”. This test measures the spontaneous erections overnight and helps discriminating between organic and psychological ED. However, this is a highly specific but low sensitive test since a positive (normal) result can roll out an organic ED and suggest a psychological etiology while a negative result cannot confirm or exclude an organic condition. Objectives In this context the aim of this study is to investigate the predictive role of Rigiscan in discriminating patients with an organic ED and the presence of vascular disease in patients with ED. Methods We conducted a prospective study in patient 25 patient who underwent a Rigiscan test as part of ED assessment. Each patient had blood tests for hormonal and metabolic analysis, a measurement of the carotid intima-media thickness (cIMT), a brachial flow-mediated vasodilation test (FMD), and a penile color doppler ultrasound (PCDU) to assess penile hemodynamics. Results Our patients had a mean age of 47.9 ± 13.7 years, with a mean IIEF score of 9.0 ± 6.5. Among them 13 (54.2%) were active smokers, 5 (20.8%) were diabetics, 8 (32%) had dyslipidemia, and 4 (16.7%) had hypertension. Eleven patients (44%) had a normal Rigiscan while 14(56%) had a pathological result. We found that patient with a pathological Rigiscan presented with a cluster of impaired vascular function at different levels. In particular, they had statistically lower peak systolic velocity (PSV) in the PCDU (52.5 vs 80.2 cm/s p=0.014) and a higher prevalence of arterial insufficiency (42.9% vs 0.0% p=0.020). Moreover, in patients with negative Rigiscan, there was a higher cIMT (0.9 vs 0.7 mm) and lower response to FMD (7.7% vs 9.6%) with a more frequent diagnose of impaired FMD (63.6% vs 46.2%) but without reaching a statistically significance. Conclusion We can conclude that a negative Rigiscan is indicative of altered penile hemodynamics and may suggests the presence of systemic vascular disease. Therefore, while a positive Rigiscan excludes organic ED, a negative Rigiscan should be considered a cardiovascular risk marker and induce the clinician to address the cardiovascular risk in that patient. More studies with larger population are warranted to confirm and further investigated these findings. Disclosure No

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

Cyber pornography use and masturbation outburst. Considerations on 150 italian patients complaining erectile dysfunction and trying to solve it.

We aimed to verify the rate of masturbation (Mst) in a group of 150 Italian patients complaining Erectile Dysfunction (ED). Our diagnostic protocol for penile and sexual problems included the collection of the patient's history, general and local clinical examination, and metabolic and hormonal analyses. Selected patients were also submitted to nocturnal penile tumescence test (Rigiscan), Duplex ultrasound of the penis, Magnetic Resonance Imaging, neurological tests and cardiological examination. A group of 150 Italian males (aged between 20 and 86 years) who complained ED and who presented to our Andrological Center to research the possibility of correcting their ED and being able to recover adequate sexual erectile activity were included in this study. In this group of patients suffering from ED we decided to evaluate the practice of Mst by asking specific questions: 1. Do you sometimes practice Mst? 2. How often in a week? 3. Is Mst hidden or known by the partner? 4. What do you use as a masturbatory sexual stimulus? The frequency of Mst was assessed according to a Likert scale as follow: a: No Mst; b:1-2/week; c: 2-3/week; d: > 3/week; e: daily or more. We also asked if it was possible to have penetrative marital intercourse on the same day as Mst (1-10 hours). We also asked what they used as a triggering sexual stimulus: press magazines, TV movies, the WEB. Only 5/150 patients did not report Mst while 27/145 pts (aged 20-30 years) reported it more than 3 times a week; 44/145 (aged 31-50 years) 1-3 times a week and 27/145 (51-86 years) 1-2 times a week. Almost all patients used WebPorn as a stimulus for Mst. A group of patients over the age of 50 said they were quite satisfied with the physical results of Mst even though they would prefer to have sex as part of a couple relationship. The outburst of Mst in this web-dominated era could affect the sexual activity of individual males and couples.

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.

PS-08-007 The findings of polysomnographic and nocturnal penile tumescence testing in men with stuttering priapism

PS-08-007 The findings of polysomnographic and nocturnal penile tumescence testing in men with stuttering priapism

1205 - The findings of polysomnographic and nocturnal penile tumescence testing in men with stuttering priapism

1205 - The findings of polysomnographic and nocturnal penile tumescence testing in men with stuttering priapism

Adding a vacuum erection device to regular use of Tadalafil improves penile rehabilitation after posterior urethroplasty.

This study aimed to evaluate whether adding a vacuum erection device (VED) to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral injury (PFUI). Altogether, 78 PFUI patients with erectile dysfunction (ED) after primary posterior urethroplasty were enrolled and divided into two treatment groups: VED combined with Tadalafil (Group 1, n = 36) and Tadalafil only (Group 2, n = 42). Changes in penile length, testosterone level, International Index of Erectile Function-5 (IIEF-5) questionnaire, Quality of Erection Questionnaire (QEQ), and nocturnal penile tumescence (NPT) testing were used to assess erectile function before and after 6 months of ED treatment. Results showed that the addition of VED to regular use of Tadalafil preserved more penile length statistically (0.4 ± 0.9 vs −0.8 ± 0.7 cm, P < 0.01). IIEF-5 score and QEQ score in Group 1 were higher than Group 2 (both P < 0.05). After treatment, 21/36 (58.3%) Group 1 patients and 19/42 (45.2%) Group 2 patients could complete vaginal penetration. Group 1 patients also had markedly improved testosterone levels (P = 0.01). Unexpectedly, there was no significant difference in NPT testing between two therapies. For PFUI patients with ED after posterior urethroplasty, the addition of VED to regular use of Tadalafil could significantly improve their conditions – improving erection and increasing penile length – thus increasing patient satisfaction and confidence in penile rehabilitation.

AB020. Usefulness of RigiScan® evaluation of nocturnal penile tumescence

BackgroundThe RigiScan® is widely used for evaluating impairment of erectile function after traumatic events such as traffic accidents, workplace injuries, and surgical operations, and is often used in preparing diagnostic reports of erectile dysfunction, which can then be used as evidence in court cases. In Japan, the Ministry of Health, Labour and Welfare requires the use of RigiScan® monitoring for evaluating nocturnal penile tumescence (NPT) when assessing disability benefits for workplace accidents. We evaluated the accuracy of RigiScan® NPT testing for diagnosing erectile function.MethodsA total of 46 men (age range, 17–65 years) presented at our clinic from January 2007 through October 2016 to obtain an official erectile dysfunction diagnosis certificate after physical trauma, including traffic accident, workplace accident, fall resulting in spinal cord injury, surgery for repair of slipped disks, surgery to correct rectoceles, and damage to the urinary tract during insertion of urethral catheters. The reason for seeking a diagnosis certificate varied: patients wished to use them as proof of disability after a workplace accident, for insurance-benefit application forms, as evidence in court cases, and for assessment of postoperative sequelae. These diagnostic reports usually require six tests: (I) general blood testing, including serum hormone levels; (II) psychological testing including the Cornell Medical index and Self-Rating Questionnaire for Depression; (III) esthesiometry of phallic and perineal pallesthesia; (IV) neurological testing of anal sphincter tonus and anal and bulbocavernosus reflexes; (V) intracavernous injection of prostaglandin E1 (ICI PGE1) followed by RigiScan® evaluation of blood vessel response; and (VI) a 3-day RigiScan® evaluation of erectile function, to assess NPT while the patient is sleeping. Normal RigiScan® values are defined as: maximum erection hardness of 65% or greater, maximum penile circumference expansion to 3 cm or more at the base and 2 cm or more at the tip, and an erection time of 10 minutes or longer.ResultsOf the 20 patients evaluated with NPT only, 16 had normal NPT results (indicating normal erectile function) and 4 had NPT abnormalities (indicating vascular disorders and/or neuropathy). The remaining 26 men were evaluated with NPT and ICI testing: NPT and ICI were both normal in 10 (indicating normal erectile function), NPT was normal but ICI was not in 5 (classified as normal erectile function), ICI was normal but NPT was not in 4 (indicating neuropathy), and both NPT and ICI were abnormal in 7 men (indicating a vascular disorder, with or without neuropathy). How the outcomes of NPT and ICI testing were defined. Of the 26 men evaluated with both NPT and ICI testing, 5 had normal erectile function despite ICI abnormality, and another 4 had neuropathy despite normal ICI test findings. In the absence of NPT testing, diagnoses would have been based solely on ICI results, and 9 cases (35% of the 26 cases) would have been misdiagnosed. During ICI testing, response of smooth muscle in the corpus cavernosum to PGE1 is affected by psychological stress in the patient. Furthermore, ICI testing cannot be used to identify neuropathy.ConclusionsWhen evaluating erectile function, RigiScan® assessment of NPT is superior to use of PGE1 ICI alone.

Preliminary Experience of Nontransecting Urethroplasty for Pelvic Fracture-related Urethral Injury

To evaluate the urinary outcomes and preservation of erectile function in patients with pelvic fracture-related urethral injury (PFUI) after nontransecting spongiosum anastomotic urethroplasty (NTSAU). Fifty-nine male patients with PFUI following traumatic pelvic fracture underwent NTSAU. Inclusion criteria were age 18-60 years, posterior urethral stenosis <2.5 cm without previous urethroplasty, and intact erectile function. Exclusion criteria were history of open urethroplasty, long-segment posterior urethral stenosis (>2.5 cm), preoperative impotency, or age over 60 years. Pre- and postoperative outcome analyses were performed with a paired t test and chi-square test. Between January 2011 and August 2015, 59 patients with a mean age of 38.5 years (range, 21-59 years) and a mean stricture length of 2.0 cm (range, 1-2.5 cm) underwent simple NTSAU (group 1, n = 41) or NTSAU with inferior pubectomy (group 2, n = 18). Patients were followed for a mean 25 months (range, 12-60 months). The primary success rate was 96.6% (57 of 59), and stricture recurrence occurred in 2 (3.4%) patients. The secondary outcomes revealed no significant changes in number of events, tip rigidity, or duration of best episode between pre- and postoperative nocturnal penile tumescence test (on RigiScan) in group 1, but a slight decrease in group 2 (P <.05). The limitation was the small sample size and heterogeneous population. NTSAU is a safe, feasible, minimally invasive procedure for PFUI, optimizing erectile preservation.

MP91-18 THE ROLE OF VACUUM ERECTION DEVICES IN PENILE REHABILITATION AFTER POSTERIOR URETHRAL ANASTOMOTIC URETHROPLASTY:A PILOT STUDY

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I1 Apr 2017MP91-18 THE ROLE OF VACUUM ERECTION DEVICES IN PENILE REHABILITATION AFTER POSTERIOR URETHRAL ANASTOMOTIC URETHROPLASTY:A PILOT STUDY Lujie Song and Qiang Fu Lujie SongLujie Song More articles by this author and Qiang FuQiang Fu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2858AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the efficacy and safety of vacuum erection devices(VED) for the penile rehabilitation in patients with pelvic fracture urethral distraction defects (PFUDD) who underwent posterior urethral anastomotic urethroplasty. METHODS This prospective study consisted of 60 patients who underwent successfully primary bulboprostatic anastomosis with a perineal approach and developed erectile dysfunction following surgery between Jan 2012 and Jun 2015. The patients were randomized to VED combined with Tadalafil (10mg) once every two days (Group 1, n=28) or Tadalafil (10mg) once every two days (Group 2, N=32) for 6 months. The International Index of Erectile Function-5(IIEF-5), nocturnal penile tumescence (NPT) testing and dynamic color-duplex Doppler ultrasonography (D-CDDU) was used as the evaluation tools. Assessments were made at 2 time points: 1 month and 7 months after urethroplasty. RESULTS The mean patient age was 31.4±7.0 years (Group 1) and 33.3±7.2 years (Group 2) repectively (p>0.05). No patients ended the penile rehabilitation program because of treatment-related adverse events in both groups. In Group 1, 57.1% (16/28) patients have erections sufficient to finish the vaginal intercourse compared to 46.9% (14/32) in Group 2 at 7 months after urethroplasty. At 7 months after urethroplasty, the IIEF-5 score is (16.5±4.0) and (13.6±4.3) respectively in Group 1 and Group 2 (p<0.05). According to D-CDDU, the cavernosal artery peak systolic velocity (PSV) is (37.1±7.4) cm/second and (31.6±9.7) cm/second (p<0.05), the cavernosal artery end diastolic velocity(EDV) is (4.1±0.9) cm/second and (4.2±1.2) cm/second (p>0.05), and the penile length change is (3.1±0.9) cm and (2.4±0.9) cm(p<0.05) respectively in Group 1 and Group 2 after drug injection. NPT testing shows that the number of erectile events is (2.4±2.0) and (2.8 ±1.7) (p>0.05), the duration of erectile events is (12.1 ±4.1) min and (11.5±4.7)min (p>0.05), and the penile Avg Event Rigidity is (26.9±10.2) cm and (26.4±11.6) cm (p>0.05)respectively in Group 1 and Group 2. CONCLUSIONS This short term study showed that early use of VED is useful and well-tolerated in the penile rehabilitation for the patients after posterior urethral anastomotic urethroplasty because of PFUDD. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1224-e1225 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Lujie Song More articles by this author Qiang Fu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Age-stratified cut-off points for the nocturnal penile tumescence measurement using Nocturnal Electrobioimpedance Volumetric Assessment (NEVA(®) ) in sexually active healthy men.

The current nocturnal penile tumescence (NPT) measurement is based on standard cut-off levels defined regardless of age. This study was conducted to provide age-stratified cut-off points for NPT measurement. Forty sexually active healthy men between 20 and 60years old were enrolled and divided equally into four groups defined by age (20-29, 30-39, 40-49 and 50-60years.). None of the candidates had sexual dysfunction or sleep disturbance or used supportive medication to enhance sexual function. Erectile function was evaluated by using the 5-item version of the international index of erectile function (IIEF-5). NPT was observed using the nocturnal electrobioimpedance volumetric assessment (NEVA(®) ). The NPT values of healthy men aged 20-60years varied from 268.7% to 202.3%. The NPT differed significantly between age groups (P<0.0009); however, no significant differences between men aged 30-39 and 40-49 (P= 0.593) were observed. Age was weakly associated with IIEF-5 scores (P=0.004), whereas a strong and negative correlation between age and NPT (P<0.0001) was found. IEF-5 scores were not significantly associated with NPT (P=0.95). Therefore, the standard values for NPT testing should be considered in the evaluation of the nocturnal penile activity of men of all ages.

The vascular and neurogenic factors associated with erectile dysfunction in patients after pelvic fractures.

ABSTRACTErectile dysfunction (ED) is a common complication of pelvic fractures. To identify the vascular and neurogenic factors associated with ED, 120 patients admitted with ED after traumatic pelvic fracture between January 2009 and June 2013 were enrolled in this study. All patients answered the International Index of Erectile Function (IIEF-5) questionnaire. Nocturnal penile tumescence (NPT) testing confirmed the occurrence of ED in 96 (80%) patients on whom penile duplex ultrasound and neurophysiological testing were further performed. Of these ED patients 29 (30%) were demonstrated only with vascular abnormality, 41 (42.7%) were detected only with neural abnormality, 26 (27.1%) revealed mixed abnormalities. Of the 55 patients (29+26) with vascular problems, 7 patients (12.7%) with abnormal arterial response to intracavernous injection of Bimix (15mg papaverine and 1mg phentolamine), 31 (56.4%) with corporal veno-occlusive dysfunction and 17 (30.9%) had both problems. Of the 67 (41+26) patients with abnormal neurophysiological outcomes, 51 (76.1%) with abnormal bulbocavernosus reflex (BCR), 20 (29.9%) with pathological pudendal nerve evoked potentials (PDEPs) and 25 (37.3%) with abnormal posterior tibial somatosensory nerve evoked potentials (PTSSEPs). Our observation indicated that neurogenic factors are important for the generation of ED in patients with pelvic fracture; venous impotence is more common than arteriogenic ED.

Forensic Identification for Erectile Dysfunction: Experience of a Single Center

To analyze the characteristics of forensic identification cases and evaluate the importance of integrating penile erection length, angle, and rigidity in diagnosing erectile dysfunction (ED). Retrospective analysis of the forensic identification cases between Jan 2009 and May 2013. Correlation between ED diagnosis and nocturnal penile tumescence (NPT) test result or the site of injury was analyzed. In total, 148 patients came for forensic identification of sexual function because of rape charges, divorce, medical accidents, or injury: 126 of 148 (85.1%) because of injury, of which 95 (75.4%) resulted from traffic accidents. There was a significant correlation between the site of injury and ED diagnosis; pelvic fracture with urethral or perineum injury was the most common. Our data showed that ED diagnosis was in general significantly associated with NPT results. However, we also identified three cases of diagnosed organic ED with normal NPT reactions. Our analyses showed that abnormal length and/or angle of the erectile penis were contributing factors to the diagnoses in these cases. In addition to NPT test, which measures the rigidity of the erectile penis, the length and angle of the erectile penis should also be considered in diagnosing ED, particularly in the case of forensic identification of sexual function.

AB162. Is it feasible to apply a new concept of erectile dysfunction syndrome (EDS) in clinical practice

How to understand the erectile function? How to define erectile dysfunction? In general, erectile function is evaluated by the quality of penile erection. If penis shows good erection, we think erectile function is normal. Otherwise, erectile dysfunction occurs. This concept is reflected in the definition of erectile dysfunction (ED). ED is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance. From the definition of ED, it is comprehensible that the penile erection is only related to the hardness of penile erection. Therefore, if the hardness of penile erection is sufficient to complete a satisfactory sexual intercourse, we could consider the erectile function is normal. Conversely, if the hardness of penile erection is not enough, erectile dysfunction is indicated. However, sometimes we meet the following kinds of patients in clinics. Firstly, the patients who are diagnosed as phallocampsis. The morphology of penis is flexural after erection: upward bending, down bending, left bending, right bending, S-shaped curve or rotating, et al. Secondly, in some patients, proximal part of penis is much more slender than glans, like a spindle. Full erection could be achieved in these patients without any abnormalities indicated by nocturnal penile tumescence (NPT) test, intracavernous pressure (ICP) measurement and color duplex ultrasonography. But the penis is very easy to swing during the sexual intercourse and the stability of penile erection is abnormal.

Impact of the Change in Urinary and Sexual Function on Health-Related Quality of Life after Once Daily Low-Dose Mirodenafil Treatment in Patients with Organic Erectile Dysfunction

Objective: We aimed to evaluate whether changes in urinary and sexual function can influence health-related quality of life. Patients and Methods: Out of 54 recruited patients, 36 were enrolled, and data for 30 participants with erectile dysfunction were available. At baseline and after 1 and 2 months, each participant completed the International Index of Erectile Function (IIEF-15), the International Prostate Symptom Score (IPSS) and the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36). Uroflowmetry, post-voiding residual volume and the nocturnal penile tumescence (NPT) test were performed at baseline and at the study's conclusion. Results: Compared with baseline, the IPSS, IIEF-15, peak urinary flow rate, NPT parameters and mental component of the SF-36 exhibited significant improvement at the study's conclusion. Among the symptomatic parameters, the changes in the storage and erectile function parameters contributed significantly to the change in the mental component score on the SF-36 (p = 0.007, R² = 0.502). Conclusions: The daily administration of low-dose mirodenafil (50 mg) produced improvements in urinary and erectile function with or without sexual stimulation. Furthermore, this therapy enhanced the mental component of health-related quality of life by improving storage and erectile symptoms.

A 35-Year-Old Man Presenting Sleep-Related Painful Erections (Erpes): A Case Report and Review of Literature

Introduction: Erectile episodes occurring in the night time are considered normal and are usually related to the REM sleep. Spontaneous painful erections are unusual but they can have a great impact in the patient’s quality of sleep and, for consequence, quality of life. Report: We present a patient who has been presenting painful erections which wake him up almost every night. We discuss the workup and treatment offered to the patient, as well as the short-time response and two months follow-up. Discussion: Although studies still do not explain this relationship, nocturnal erections occur only during rapid eye movement (REM) sleep, which can be confirmed by polysomnography accompanied by Nocturnal Penile Tumescence testing or RigiScan test. However, diagnosis can be established based exclusively on clinical aspects. Based on all literature reviewed, the initial treatment should safely consist in improvement in sleep architecture and pelvis muscles relaxation. Conclusion: After the first suspicion, polysomnography with rigidity measurements of nocturnal erections should be considered although clinical diagnosis and therapeutic test may be acceptable. The management we suggest is usually effective, well tolerated and sustained.

Anterior urethral fusion for treatment of complete penile diphallia: a case report and literature review

Objective To evaluate the efficacy,safety and clinical value of anterior urethral fusion to treat diphallia. Methods A 17-year-old male patient with complete penile diphallia was treated in March 2011.The physical examination showed two completely separated mature penis; urethrography,and urethroscope showed the two urethras were completely separated and entered the bladder respectively.Two anterior urethras were incised respectively at ventral sides ( from the meatus to bulbar urethra) and then two incised anterior urethras were splintered by a continuous suture with 4-0 polyglactin sutures in side and side.Two penises were splintered into one.The nocturnal penile tumescence test and the penis vibration thresholds were assessed before,and after surgery.. Results The patient was followed up for 12 months.There was no hematoma,urinary fistula,urinary incontinence and other complications postoperatively.The penis was recovered with normal appearance; urination and morning erection of penile were normal.6 months after surgery,there was no significant difference in the nocturnal penile tumescence and penis vibration thresholds detection ( P ＞ 0.05). Conclusion The operation of anterior urethral fusion is a safe and efficient surgical treatment to treat partial complete penile diphallia with less complication and no worse effect on urination and erection of penile. Key words: Diphallia; Urethral fusion; Treatment