Isotope Phallogram: Preliminary Communication

Townell, N. H.; Siraj, Q. H.; Hilson, A. J.W.; Dick, Robert; Morgan, RJ

doi:10.1177/014107688507800709

“…5,6,8,10,15,21 Intracavernosal (IC) injection of vasoactive drugs 9,16,17,22 is currently preferred as a more effective and reproducible method of achieving tumescence, although some authors still feel that audio-visual stimulation is more physiologic and therefore superior. 23 It is important to limit the volume of vasoactive injectate, so as not to signi®-cantly alter the hematocrit of trapped blood, thereby disturbing quantitative calculations.…”

Section: Theorymentioning

confidence: 99%

“…This measure correlated well with the penile to brachial blood pressure index 8 and with arteriographic diagnosis. 10 Siraj and coworkers 15 added a vasodilator response or¯ow 17 index, which relates the relative difference in slopes of the TACs before and after vasoactive medication, normalized for counts in the iliac vessels. In the assessment of penile¯ow reserve, this index is a logical approach to quanti®cation of in¯ow which occurs during erectile stimulation.…”

Section: Historical Developmentmentioning

confidence: 99%

Use of radioactive tracers in the evaluation of penile hemodynamics: history, methodology and measurements

Zuckier

¹

1997

Int J Impot Res

3

0

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Radionuclide tracer techniques are intimately associated with some of the early ground-breaking investigations in erectile dysfunction and have evolved along with the ®eld. At the present time, the various investigations can be grouped into four categories: labeled blood-pool; tracer washout; tracer washin and combined blood-poolatracer and tracer washout examinations. Blood pool studies are most useful in assessing the integrity of arterial in¯ow, but may also be used to generate indices of venous leak. A non-imaging version of the blood-pool test may represent a simple and cost-effective alternative. Washout of intracavernosal xenon during erection seems the most rigorous method of testing venous integrity. Washout using 99m Tc-labeled substances may emerge as a convenient alternative to the more technically dif®cult xenon examinations. Dual-isotope blood pool and washout examinations, though complicated, represent an ideal method of analyzing penile hemodynamics, with potential to contribute signi®cantly to the understanding of penile physiology. Development of improved pharmacologic stimuli and augmentation of testing protocols by intracavernosal pressure monitoring may further improve the utility of quantitative and physiologic nuclear medicine examinations in erectile dysfunction.

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Detailed investigation of the cause of impotence in 20 diabetic men

Ryder¹,

Facey²,

Hayward³

et al. 1991

Pract. Diab. Int.

1

0

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To clarify the cause of their impotence, 20 diabetic patients underwent detailed assessments of: diabetic autonomic neuropathy (acetylcholine sweatspot test, pupil test‐PD%, five cardiovascular tests); vascular disease (radioisotope phallogram, response to intracorporeal papaverine); nocturnal penile rigidity; psychiatric disturbance (General Health Questionnaire). Results suggested cause as: vascular 7/20 (35%), vascular and autonomic neuropathy 7/20 (35%), autonomic neuropathy 3/20 (15%), psychiatric disturbance 2/20 (10%), beta‐blockers 1/20 (5%). The sweatspot test appeared to be the most sensitive assessment of autonomic neuropathy. Investigations suggested an alternative aetiology in all cases with a normal sweatspot test. In one patient with autonomic neuropathy, high deep‐artery velocity on Doppler but loss of papaverine‐induced erection, dynamic cavernosography revealed venous leakage; impotence was improved by surgical venous ligation. The results suggest that most impotence in diabetics has an organic basis. The sweatspot test (ideally in conjunction with cardiovascular tests and pupil test) and response to intracorporeal papaverine may identify and categorise most of these patients. Those with normal tests are unlikely to have organic disease and could be referred for psychosexual/psychiatric counselling. Doppler studies may identify those who need investigating for venous leakage. The others could then, in the first instance, be offered one of the recently described non‐invasive devices for overcoming diabetic impotence. Self‐administered intracorporeal papaverine may also be considered, but only a minority of diabetic patients seem to respond.

show abstract

Detailed investigation of the cause of impotence in 20 diabetic men

Ryder

¹

,

Facey

²

,

Hayward

³

et al. 1992

View full text Add to dashboard Cite

To clarify the cause of their impotence, 20 diabetic patients underwent detailed assessments of: diabetic autonomic neuropathy (acetylcholine sweatspot test, pupil test‐PD%, five cardiovascular tests); vascular disease (radioisotope phallogram, response to intracorporeal papaverine); nocturnal penile rigidity; psychiatric disturbance (General Health Questionnaire). Results suggested cause as: vascular 7/20 (35%), vascular and autonomic neuropathy 7/20 (35%), autonomic neuropathy 3/20 (15%), psychiatric disturbance 2/20 (10%), beta‐blockers 1/20 (5%). The sweatspot test appeared to be the most sensitive assessment of autonomic neuropathy. Investigations suggested an alternative aetiology in all cases with a normal sweatspot test. In one patient with autonomic neuropathy, high deep‐artery velocity on Doppler but loss of papaverine‐induced erection, dynamic cavernosography revealed venous leakage; impotence was improved by surgical venous ligation. The results suggest that most impotence in diabetics has an organic basis. The sweatspot test (ideally in conjunction with cardiovascular tests and pupil test) and response to intracorporeal papaverine may identify and categorise most of these patients. Those with normal tests are unlikely to have organic disease and could be referred for psychosexual/psychiatric counselling. Doppler studies may identify those who need investigating for venous leakage. The others could then, in the first instance, be offered one of the recently described non‐invasive devices for overcoming diabetic impotence. Self‐administered intracorporeal papaverine may also be considered, but only a minority of diabetic patients seem to respond.

show abstract

Isotope Phallogram: Preliminary Communication

Cited by 3 publications

References 10 publications

Use of radioactive tracers in the evaluation of penile hemodynamics: history, methodology and measurements

Use of radioactive tracers in the evaluation of penile hemodynamics: history, methodology and measurements

Detailed investigation of the cause of impotence in 20 diabetic men

Detailed investigation of the cause of impotence in 20 diabetic men

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