During penile pharmacotesting, anxiety may overcome complete smooth muscle relaxation and lead to false positive diagnosis of organic male erectile dysfunction (ED). We tested the ef®cacy and safety of re-dosing of PGE 1 alone versus combination of PGE 1 and the a 1,2 -blocker phentolamine (PHE) to improve an incomplete pharmaco-induced erection during color-power-Doppler (CPD) sonography. 116 consecutive impotent patients were submitted to CPD and injected with 10 mg PGE 1 plus audiovisual sexual stimulation. Clinical evaluation of rigidity and CPD parameters were normal in 26 patients while in the remaining they were upgraded in 15% and 35% after redosing of 10 mg PGE 1 alone and 10 mg PGE 1 plus 1 mg PHE, respectively (P`0.05); furthermore, in these latter patients CPD studies showed increased visualisation of distal rami®cations of helicine arterioles. The ®nal diagnosis was changed in those patients who responded to re-dosing with no differences in the occurrence of prolonged erections between the two treatments. We conclude that re-dosing of PGE 1 aPHE mixture is a safe and effective procedure to maximize erectile response during dynamic CPD sonography and has a better diagnostic sensitivity than re-dosing of PGE 1 alone.
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