Penile Doppler Ultrasonography Research Articles

Can the PDE5 Inhibitor Replace Intracavernosal Injection as a Method for Inducing a Penile Erection during the Evaluation of Erectile Dysfunction Using Penile Duplex Ultrasonography?

Purpose: To clarify whether vardenafil can be used as a substitute for intracavernosal injection as a method of induction of penile erection, we compared the outcome of penile duplex Doppler ultrasonography using both methods in the same patient with erectile dysfunction. Materials and Methods: A total of 23 patients underwent penile duplex ultrasonography twice with a one week interval between procedures. Twelve were randomly selected for intracavernosal injection first with prostaglandin E1 (PGE1) 20μg and the remaining 11 were initially treated with oral vardenafil 20mg 1 hour before the Doppler study and in addition had visual sexual stimulation using a head-mounted display during the study. The peak systolic velocity (PSV), end diastolic velocity (EDV) and the degree of maximum erectile response were measured and compared between the two groups. Results: Measurements from the PGE1 treatment were not significantly different from those with the vardenafil treatment. The percentage of compatibility between the two methods with regard to hemodynamic diagnosis and pharmaceutical erectile response was as high as 83% (19 of 23) and 91% (21 of 23), respectively. Both methods were tolerable and safe without severe complications. However, in 4 patients where the diagnosis was uncertain, the injection method provided a more accurate interpretation of the penile vascular status with duplex ultrasonography. Conclusions: These results suggest that oral vardenafil can be used as an initial method for inducing penile erection when assessing erectile dysfunction with penile duplex Doppler ultrasonography in selected patients with erectile dysfunction. (Korean J Urol 2008;49:641-646) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Is deep dorsal vein arterialization effective in elderly patients?

Arterialization operations of the penis are recommended for young patients with erectile dysfunction (ED). In this study, we investigated the efficiency of deep dorsal vein arterialization (DDVA) in carefully selected healthy elderly patients An initial extensive evaluation with corpus cavernosum electromyography, cavernosometry, and penile doppler ultrasonography was performed for 43 elderly patients with ED for whom the presence of risk factors (hypertension, diabetes, hyperlipidemia, smoking habit, psychiatric or neurologic disorders, liver or kidney failure, and history of major trauma) had been ruled out. All patients underwent to DDVA using the Furlow-Fisher technique. Surgical outcome was tested postoperatively by use of the fifteen-item International Index of Erectile Function questionnaire (IIEF-15). Surgical success was assumed if the score in the five-item version of the IIEF (IIEF-5) had increased by at least five points. Of the patients, 21 were detected to have caverno-occlusive disease, 13 had arteriogenic disease, and 9 had both caverno-occlusive and arteriogenic disease. The mean age of the patients was 59.7+/-4.6 years and the mean follow-up time was 22.1+/-7.1 months. The operation was successful in 26 cases (60.5%) according to IIEF-5. Total IIEF-15 score was increased from 19.2+/-5.0 to 28.5+/-9.4 (P<0.05). Significant increases were observed in the erectile function, intercourse satisfaction, and overall satisfaction domains of IIEF-15. The preoperative degree of ED or the etiology of ED had no impact on the surgical results. Percent changes in the total IIEF-15 score and in its domains were no different between patients aged <60 and those aged >or=60. DDVA could successfully be performed for carefully selected elderly patients as long as the presence of risk factors for ED are ruled out.

Different hemodynamic responses by color Doppler ultrasonography studies between sildenafil non-responders and responders

To determine if there are different penile hemodynamic patterns between sildenafil non-responders and responders by using color Doppler ultrasonography. A total of 69 erectile dysfunction (ED) patients aged 22-79 years were enrolled into the present study. Thirty-eight (55.1%) men with ED who did not respond to four attempts of treatment with 100 mg sildenafil after re-education were classified as sildenafil non-responders. A combination of three vasodilator drugs, 1.25 mg papaverine, 0.4 mg phentolamine and 5 mg prostaglandin E1, was given by intracavernous injection before penile Doppler ultrasonography was carried out. The erectile response to intracavernous injection and vascular parameters including peak systolic velocity (PSV), resistance index (RI), end diastolic velocity (EDV) and cavernosa artery diameter (CD) were measured and the results between sildenafil non-responders and responders were compared. No statistical difference in vascular parameters measured by Doppler ultrasonography studies between non-responders and responders was noted. Sildenafil non-responders had a poorer penile rigidity response to intracavernous injection than responders (P < 0.05). Among patients with adequate PSV (>or=30 cm/s) and abnormal EDV (> 5 cm/s), individuals in the non-responder group had fewer positive responses to intracavernous vasodilator injection than in the responder group (35.3% vs. 72.2%, P < 0.05). Advanced age and comorbidity with diabetes mellitus were significantly associated with sildenafil non-response (P < 0.05). Sildenafil non-responders were characterized by a poorer penile rigidity response to intracavernous injection and had an associated impaired veno-occlusive mechanism. Advanced age and comorbidity with diabetes mellitus were two common factors associated with non-response.

Priapismo: diagnóstico y tratamiento

Priapism, prolonged and painful erection, is an exceptional cause of consultation in the pediatric population. High- and low-flow priapism and recurrent prolonged erection must be differentiated, as the prognosis and treatment of these entities differ. Assessment of patients with priapism begins with a detailed history, physical examination, and complete blood cell count. The definitive diagnosis is given by penile Doppler ultrasonography, corpora cavernosa blood gas analysis, and pelvic arteriography. We present two patients who attended our emergency service in the last year and propose an algorithm for the diagnosis and treatment of this entity.

Doppler evaluation of erectile dysfunction – Part 2

Doppler evaluation in erectile dysfunction (ED) has a significant role in determining the cause of ED. The advantages of penile Doppler and pharmacologic duplex ultrasonography include objective, minimally invasive evaluation of penile hemodynamics at a relatively low cost. Arteriogenic ED may be secondary to peripheral vascular disease and diabetes, or may be seen in association with coronary artery disease. Various parameters, such as diameter of the cavernosal artery, peak systolic flow velocity, degree of arterial dilatation and acceleration time, have been suggested for the diagnosis of arteriogenic ED, but peak systolic flow velocity is the most accurate indicator of arterial disease. This second part of the review article describes the various causes of ED and the interpretation and evaluation of color flow Doppler examination in ED.

Psycho‐Biological Correlates of Free‐Floating Anxiety Symptoms in Male Patients With Sexual Dysfunctions

Anxiety has a relevant impact on everyday life, including sexual life, and therefore is considered the final common pathway by which social, psychological, and biological stressors negatively affect sexual functioning. The aim of this study is to define the psycho-biological correlates of free-floating anxiety in a large sample of patients complaining of erectile dysfunction (ED)-based sexual problems. We studied a consecutive series of 882 ED patients using SIEDY, a 13-item structured interview, composed of 3 scales that identify and quantify organic, relational, and intrapsychic domains. MHQ-A scoring from Middlesex Hospital Questionnaire (MHQ) was used as a putative marker of free-floating anxiety symptoms (AS). Metabolic and hormonal parameters, nocturnal penile tumescence (NPT) test, and penile Doppler ultrasound (PDU) examination were also performed. MHQ-A score was significantly higher in patients complaining of difficulties in maintaining erection and in those reporting premature ejaculation (6.5 +/- 3.3 vs 5.8 +/- 3.3 and 6.6 +/- 3.3 vs 6.1 +/- 3.3, respectively; both P < .05). Moreover, ASs were significantly correlated to life stressors quantified by SIEDY scale 2 (relational component) and scale 3 (intrapsychic component) scores, as dissatisfaction at work or within the family or couple relationships. Among physical, biochemical, or instrumental parameters tested, only end-diastolic velocity at PDU was significantly (P < .05) related to ASs. In conclusion, in patients with ED-based sexual problems, ASs are correlated to many relational and life stressors. Conversely, organic problems are not necessarily associated with MHQ-A score.

Evaluation of the Nervous and Vascular Systems in Erectile Dysfunction Patients after Electric Injuries

Purpose: There is a high prevalence of erectile dysfunction (ED) after electric injuries, but our medical understanding of ED after electric injuries is scanty at best. Thus, the authors attempted to investigate nocturnal penile tumescence (NPT), bulbocavernosus reflex latency (BCRL) and penile duplex Doppler ultrasonography (PDDU) for the patients who suffer from ED after electric injuries. Materials and Methods: Of the patients who visited our Burn Care Center between January 2005 and February 2006, ten male patients (aged 20 or older) who complaining of ED after electric injuries underwent NPT, BCRL and PDDU. Results: The patients' mean age was 38.1 years (age range: 25-54), and the numbers of patients exposed to whole body, upper-lower extremity and upper-upper extremity pathways of the electrical current were 1, 2 and 7, respectively. For the patient exposed to the whole body pathway, abnormal findings were observed on all the tests. For one patient who experienced two upper-lower extremity pathways, normal findings were seen on all the tests, while the other patient showed an abnormal NPT, an normal BCRL and an arteriogenic ED. Three of the patients who experienced the upper-upper extremity pathway showed normal findings on all the tests. The other two in the group showed an abnormal NPT, a normal BCRL and arteriogenic ED; the other one showed a normal vascular function, a abnormal NPT and no reaction to BCRL; the other one showed an abnormal NPT, a delayed BCRL and an arteriogenic ED. Conclusions: More abnormal findings were seen in NPT, BCRL and PDDU for the cases associated with upper-lower body or whole body electrical current pathways, as compared to patients whose electrical pathways were limited to the upper body. (Korean J Urol 2006;47:769-772) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Vardenafil compared with papaverine in penile Doppler ultrasonography

Vardenafil compared with papaverine in penile Doppler ultrasonography

Prevalence of Premature Ejaculation in Turkish Men With Chronic Pelvic Pain Syndrome

Chronic pelvic pain syndrome is a common and serious health problem affecting the quality of life in men. Limited studies exist on the relation of this condition to premature ejaculation. We evaluated prevalence rates of premature ejaculation in Turkish male patients with chronic pelvic pain syndrome and compared them with healthy control subjects. Sixty-six men with chronic pelvic pain syndrome were included in the study (group 1). A questionnaire consisting of 2 parts--demographic data and a Turkish version of the National Institutes of Health Chronic Prostatitis Symptom index--was administered to all patients. Premature ejaculation was defined as intravaginal ejaculation latency of less than 2 minutes with the same partner for at least 6 months. All patients were evaluated with physical examinations and routine laboratory tests. If erectile dysfunction was noted from the medical history, penile Doppler ultrasonography also was performed. The results were compared with the results of 30 healthy men without urinary symptoms (group 2). The chi2 test was used for statistical analyses. Of 66 patients with chronic pelvic pain syndrome, 51 had premature ejaculation (77.3%), and in 10 (15.2%) patients, premature ejaculation and erectile dysfunction were found together. Penile Doppler ultrasonography showed no vascular pathology in patients with erectile dysfunction. The rate of premature ejaculation was higher in patients in the study group than it was in patients in the control group, and this difference was statistically significant (P < .05). Both chronic pelvic pain syndrome and premature ejaculation are common disorders, but their ethiopathogeneses are not well understood. In Turkish men with chronic pelvic pain syndrome, the incidence of psychogenic sexual problems was higher than in the normal population.

Effectiveness of Vardenafil versus Papaverine in Penile Doppler Ultrasonography

Purpose: To evaluate erectile dysfunction, penile color Doppler ultrasound is currently considered the best method. But intracavernous injection is invasive and has adverse effects, such as prolonged erection and risk of priapism. In our study we want to evaluate whether vardenafil can be used instead of papaverine in penile Dopp-ler ultrasonography. Materials and Methods: A total of 24 patients with erectile dysfunction underwent color Doppler ultrasound before and after intracavernous injection of 60 mg papaverine with genital and audiovisual sexual stimulation. Peak flow and end diastolic velocity were measured in the recorded waveforms obtained 0, 1, 5, 10 and 20 min after injection. The patients also underwent color Doppler ultrasound after a 10-mg oral dose of vardenafil with genital and audiovisual sexual stimulation and at least 5 days after the prior examination. The same parameters were measured at 30, 45, 60, 75 and 90 min after the drug administration. We compared the results with the values obtained after papaverine injection. Results: After oral vardenafil mean peak flow velocity significantly increased starting at 30 min and achieving a maximum value at 60 min. There were no significant differences in the 2 methods in mean peak velocity 1, 5, 10 and 20 min after papaverine injection, and 30, 45, 60, 75 and 90 min after oral vardenafil administration. Although papaverine injection is the gold standard for penile color Doppler ultrasound, it has severe adverse effects such as prolonged erection which we observed in 3 patients (12,5%) and required pharmacological detumescence. After vardenafil no severe adverse effects were observed. Conclusions: Vardenafil administration achieved increased peak flow velocity comparable to that after intracavernous papaverine injection. With no prolonged erection vardenafil is a safer alternative compared to more invasive intracavernous injection and is also an alternative for patients who fear injections.

Alcock's canal releasing for pudendal artery syndrome resulting from gunshot injury

A 21-y-old man applied to hospital with a complaint of erectile dysfunction, which started soon after a gunshot injury. The entry of the bullet was at the middle right gluteal region without any exit hole. A pelvic X-ray revealed the bullet and the scattered particles. On penile Doppler ultrasonography, the peak systolic velocities (PCV) of the right and the left cavernosal arteries were 19 and 29 cm/s, respectively. Pudendal angiography revealed poor visualization of the right pudendal artery below the level of the bullet. The patient underwent a right-sided Alcock's canal releasing surgery. After the operation, on control penile Doppler ultrasonography, PCV on the right and the left cavernosal arteries were 53 and 35 cm/s, respectively. The control angiography revealed a normal right pudendal artery. The patient was fully potent 2 y after the operation. Not only the entrapment of pudendal nerve but also the pudendal artery may cause Pudendal canal syndrome. A gunshot injury may cause such a condition due to the reaction caused by the bullet. Pudendal canal decompression is a simple and effective treatment for pudendal canal syndrome.

Preoperative corporal biopsy as a predictor of postoperative results in venoocclusive erectile dysfunction.

Our aim was to investigate the association of corporeal cavernosal pathology with venoocclusive erectile dysfunction (ED) and whether preoperative corporeal biopsy can help predict postoperative results. A total of 36 patients with venoocclusive ED underwent corporeal cavernosal biopsy and venous ligation. Preoperative assessment included complete physical examination, international index of erectile dysfunction (IIEF) scoring, nocturnal penile tumescence, penile Doppler ultrasonography, cavernosography, and, if needed, cavernosometry. Three months after surgery, all patient parameters were reevaluated and compared with the preoperative results. Biopsy results of 43 patients with penile fracture were used for controls. The mean follow-up was 49.0 +/- 24.1 months. The mean age of the patients with ED was 32.1 +/- 8.6 years. Venous leakage was clearly revealed by cavernosography in all patients, preoperatively. The IIEF score and peak systolic velocity of the cavernosal artery in the patients did not differ postoperatively. The mean end diastolic velocity (EDV), however, decreased from 11.0 cm/s to 5.1 cm/s (P = .023). Only 2 patients had satisfactory penile rigidity after venous ligation, 2 were helped by intracorporeal injection to achieve full rigidity, and 1 used oral sildenafil to achieve full rigidity. Pathologically, 23 patients had a slight decrease of cavernosal smooth muscle cells, while in 9 patients, the cavernosal smooth muscles were markedly decreased and replaced by collagen fibers. Four patients had normal histologies, and all responded either partially or completely to surgical therapy. In the control group, 41 of 43 patients had a normal histologies, and 2 had a slight decrease of smooth muscle cell mass. Decreased cavernosal smooth muscle mass may impair erectile function. Its association with venoocclusive ED may be a poor prognostic factor of the outcome of surgical therapy. For the preoperative evaluation of patients, we propose cavernosal biopsy.

38-Year-Old Man With Priapism and a History of Paranoid Schizophrenia

38-Year-Old Man With Priapism and a History of Paranoid Schizophrenia

Phentolamine re-dosing during penile dynamic colour Doppler ultrasound: a practical method to abolish a false diagnosis of venous leakage in patients with erectile dysfunction

Increased sympathetic tone may cause an equivocal response to a prostaglandin E1 (PGE1) penile Doppler ultrasound (US) examination interpreted as a venous leak. We evaluated the US parameters and erectile response to the addition of phentolamine to a PGE1 penile Doppler US examination to ascertain whether addition of phentolamine would abolish a suboptimal response. 32 patients (median age 29 years, range 17-70 years) with either a previous Doppler US pattern of venous leakage or a clinical suspicion of venogenic impotence, underwent Doppler US after a total dose of 20 microg of PGE1. Peak systolic velocity (PSV), end diastolic velocity (EDV) and grade of erection were documented. If erectile response was suboptimal irrespective of the EDV measurement, 2 mg-intracavernosal phentolamine was administered and measurements repeated. Six patients had a normal erectile response, the remaining 26 received phentolamine. A significant increase in PSV between baseline and 20 microg PGE1 (p<0.001) was observed in all cases. Following phentolamine there was a significant increase in grade of erection (p=0.0001) and a significant reduction in the EDV (p=0.0001). A reduction of the EDV to below 0.0 cm s(-1) was observed in 16 patients. Four patients with EDV <5.0 cm s(-1) but >0.0 cm s(-1) had improved erectile response following phentolamine while six showed persistent EDV elevation >5 cm s(-1). No priapism was documented. It is essential to ensure cavernosal relaxation using phentolamine before a Doppler US diagnosis of venous leak is made. This two-stage assessment will allow this to be done efficiently and with a low risk of priapism.

Screening for ischemic heart disease in patients with erectile dysfunction: Role of penile Doppler ultrasonography

Objectives To assess the role of measuring cavernosal artery blood flow as a screening tool for ischemic heart disease in patients with erectile dysfunction (ED). Methods A total of 303 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. The penile vasculature was assessed using color Doppler ultrasonography and the Digital Inflection Rigidometer. All patients were referred to a cardiologist for evaluation of ischemic heart disease (IHD). All patients underwent routine laboratory investigations, plus total testosterone and prolactin assessments. Results Seventy-six percent of the patients had organic causes of ED. Of the 303 patients, 31.4% had different degrees of IHD. A statistically significant association was found between the presence of IHD and arteriogenic causes of ED, a poor response to intracorporal injection, poor rigidity in the Digital Inflection Rigidometer, and low peak systolic velocity (PSV) in the cavernosal arteries ( P <0.05 for each). No statistically significant association was found between the presence of IHD and increasing end-diastolic velocity values or decreasing resistive index in the cavernosal arteries ( P >0.05 for each). A statistically significant association was found between a higher grade of IHD and a decreasing PSV value ( P <0.05). Conclusions The results of this study established that a reduced PSV of the cavernous artery is associated with IHD. Determining the PSV could be a reliable screening tool for the detection of IHD in patients with ED.

Assessing comfort, safety, and patient satisfaction with three commonly used penile compression devices

Objectives To assess the safety, efficacy, comfort, and patient satisfaction with three penile compression devices: the Cunningham clamp, C3, and U-Tex. Methods The devices were tested in random order in a multiple-period, crossover study design using a Latin squares configuration. The subjects had undergone radical prostatectomy 6 months or more before the study, had no neurologic or cognitive impairment, and had not undergone radiotherapy. Baseline penile Doppler ultrasonography was followed by ultrasound scanning with each device. In random order, subjects completed a 4-hour pad test, with and without each device, and the questionnaire. Results Twelve men completed the study. The mean Mini-Mental State Examination score was 29.6 (SD 1.2, range 27 to 30). The mean urine loss at baseline was 122.8 g (SD 130.8). The mean urine loss with each device was 53.3 g (SD 65.7) with the U-Tex, 32.3 g (SD 24.3) with C3, and 17.1 g (SD 21.3) with the Cunningham clamp ( P <0.05). No device had an impact on the resistive index; the C3 and U-Tex allowed good cavernosal artery flow, and the Cunningham clamp significantly lowered the distal blood flow velocity (from 12.5 to 7.3 cm/s [left systolic velocity] to 9.5 cm/s [right systolic velocity]) even at the loosest setting. The Cunningham clamp was ranked positively by 10 of 12 men; 2 of 12 men rated the C3 positively; none rated the U-Tex positively. Conclusions The Cunningham device was the most efficacious and most acceptable to users, but also contributed to reduced systolic velocity in all men. None of the devices completely eliminated urine loss when applied at a comfortable pressure. Individualized instruction to cognitively capable men is necessary to ensure appropriate application, comfort, and fit.

Penile axial rigidity and Doppler ultrasonography parameters in patients with erectile dysfunction: association with type 2 diabetes

ObjectivesTo determine the association between diabetes and changes in penile Doppler ultrasonography and axial penile rigidity parameters in patients with erectile dysfunction (ED). MethodsA total of 1023 male patients with ED were enrolled in this study. Patients were assessed for ED using the International Index of Erectile Function. All patients were also interviewed to obtain medical history, including history of diabetes, duration of diabetes, and diabetes-related complications. Patients underwent routine laboratory investigations, glycosylated hemoglobin, free testosterone, and prolactin assessment. All patients were offered additional assessment for erectile function using color Doppler ultrasonography and the Rigidometer. Of the 1023 patients, 627 accepted additional assessment, of whom 481 had diabetes and 146 did not. ResultsThe mean age ± SD was 51.7 ± 9.7 years. Patients had varying degrees of ED—mild in 10.8%, moderate in 36.9%, and severe in 52.3%. A statistically significant association was found between the presence of diabetes and a poor response to intracorporeal injection and decreasing peak systolic velocity values and Rigidometer values (P <0.001 for each). No statistically significant association was found between the presence of diabetes and increasing values of end-diastolic velocity or decreasing values of the resistive index (P >0.05 for each). In diabetic patients, a statistically significant association was noted between a longer duration of diabetes, poor control of diabetes, and the presence of more than one diabetes-related complication and a decreasing response to intracorporeal injection, decreasing values of peak systolic velocity, resistive index, and Rigidometer, and increasing values of end-diastolic velocity (P <0.05 for each). ConclusionsDiabetes mellitus negatively affects patients’ response to intracorporeal injection and is associated with low peak systolic velocity and poor penile axial rigidity.

A classification based on peak systolic velocity and end diastolic velocity predicts sildenafil citrate success

To attempt to predict the success rate of sildenafil citrate in erectile dysfunction patients using penile Doppler ultrasonography (PDU) measurements of peak arterial velocity and end diastolic velocity. A total of 212 patients (age range 27-76 years) with vascular pathologies were included in the study. Following a PDU test, the patients were divided into arterial insufficiency, veno-occlusive dysfunction and mixed vascular pathology groups. Subsequently, patients were given sildenafil citrate 50 mg and re-evaluated 1 month later to determine its efficacy. If it was ineffective, the dose was increased to 100 mg and patients were reassessed. Arterial insufficiency and veno-occlusive dysfunction patients were classified into mild, moderate and severe groups depending on peak systolic and end diastolic velocities. The overall response rate in patients with arterial insufficiency was 74.5%, regardless of the degree of arterial insufficiency or the dose of sildenafil. The severe arterial insufficiency group had a much better response to 100 mg compared to 50 mg doses of sildenafil. Although the 50 mg sildenafil dose was effective in patients with minimal veno-occlusive dysfunction, 100 mg was better than 50 mg to achieve adequate erection in the mild and severe veno-occlusive dysfunction groups. Sildenafil was ineffective in patients with severe arterial and venous insufficiency. PDU and a simple classification of PDU velocity measurements can provide some important clues to the prognosis of treatment and avoid overtreatment and unnecessary office visits.

New concept parameters of RigiScan in differentiation of vascular erectile dysfunction: is it a useful test?

The aim of this study is to investigate the value of new nocturnal penile tumescence recording parameters, such as tumescence activity unit and rigidity activity unit values, total erection number and erection times, in differentiating between psychogenic erectile dysfunction and organic erectile dysfunction. We also aimed to determine the role of these parameters in differentiating arterial erectile dysfunction from veno-occlusive dysfunction. Eighty-seven consecutive patients were allocated into three groups as psychogenic, arterial and venous erectile dysfunction after investigations. Nocturnal penile tumescence recording parameters between psychogenic and vascular erectile dysfunction and arterial and veno-occlusive dysfunction were compared. Mann-Whitney U-test, Pearson's chi2 test and correlation coefficient tests were used for statistical analysis. Depending on intracavernous injection, penile Doppler ultrasonography and cavernosometry tests, 37 patients (43%) had psychogenic impotence while 50 (57%) had organic pathologies. Of the 50 patients diagnosed with vascular impotence, 29 (48%) had arterial failure and 21 (42%) had veno-occlusive dysfunction. Nocturnal penile tumescence recording revealed psychogenic erectile dysfunction in 34 patients (39%) and vascular erectile dysfunction in 53 patients (61%). Nocturnal penile tumescence recording has been regarded as the gold standard and, in our series, it showed 90.6% sensitivity and 88.2% specificity in differentiating the cause of erectile dysfunction. Values of rigidity activity unit and tumescence activity unit were significantly higher in patients with psychogenic impotence (P < 0.001), when compared with vascular impotence. In patients with a vascular cause, no difference was found between arterial failure and veno-occlusive dysfunction with regard to tip tumescence activity unit, base tumescence activity unit, tip rigidity activity unit, base rigidity activity unit and erection time (P > 0.001). However, patients with arterial failure had less erection than patients with veno-occlusive dysfunction (P < 0.001). New recording parameters of nocturnal penile tumescence can differentiate organic and psychogenic erectile dysfunction more precisely. However, these recording parameters cannot distinguish subgroups with a vascular cause of erectile dysfunction.

Objective Penile Vascular Response to Intraurethral Prostaglandin E2 (Dinoprostone)

Purpose: Intraurethral prostaglandin E₂ (PGE₂) administration is a noninvasive treatment modality for erectile dysfunction. The purpose of this study was to evaluate the objective effects of this agent by measuring peak systolic velocities of cavernosal arteries after intraurethral PGE₂ administration and comparing with the results obtained with an intraurethral placebo gel and intracavernous papaverine injection. Materials and Methods: The study group consisted of 22 consecutive impotent volunteers with a mean age of 46 years who had normal penile arterial responses as determined by penile arterial responses on papaverine-stimulated penile duplex ultrasonography. The peak systolic velocity in cavernosal arteries was recorded after intracavernous injection of 60 mg of papaverine. All patients received 1 mg of intraurethral PGE₂ gel and placebo at 15-day intervals. The peak systolic velocities were recorded after each treatment. Results: Mean peak systolic velocity achieved by intraurethral administration of PGE₂ gel (25 ± 8 cm/s) was less than that achieved by intracavernous papaverine (40 ± 6 cm/s) but higher than that obtained by placebo (15 ± 4 cm/s). Twelve patients had erections, while 9 had partial and 1 had no erection with intraurethral PGE₂. Placebo did not cause any erections. No serious side effects were observed. Conclusion: Intraurethral administration of PGE₂ appears to be an effective and simple method for increasing penile arterial flow and can be used during penile Doppler ultrasonography to stimulate the penile arterial system.