Pharmacocavernosography in the Evaluation of Erectile Failure

Abstract

A total of 148 patients with erectile dysfunction underwent evaluation with Doppler sonography, cavernosography and intracavernous injections of papaverine. Arterial insufficiency was found in 63 patients (42.5%). Cavernosography following intracorporeal injection of papaverine revealed abnormal venous drainage from the cavernous bodies in 25 patients (17%) which, in 3 cases, was associated with Peyronie’s disease. Results of vascular investigations were compared with the erectile response to the application of papaverine. Vascular insufficiency was observed in 39 of 55 patients (70%) with a poor response to papaverine. No patient with a venous insufficiency showed a good response. Nevertheless a poor response to papaverine did not exclude psychogenic impotence.

Present State of Diagnostic Management in Veno-Occlusive Dysfunction

“…Thus, combination of pharmacocavernosography with simultaneous pharmacocavernosometry, evaluable only under maintenance flow rate conditions with an intracav ernosal perssure of 80 mm Hg, at least [21,29,30] local izes the leakage and confirms the diagnosis [19,31,32].…”

“…Without any previous injection of vasoactive sub stances, cavernosography merely visualizes the configura tion of corpora cavernosa and the physiological venous drainage systems during flaccidity [19,20], This type of cavernosography should be reserved for special examina tions such as detection of lesions after traumatic penile injuries (penile fracture) and visualization of a suspected invasion of penile cancer or métastasés to the corpora cavernosa. A further indication is the investigation of pro longed erection differentiating high-flow and stasis pria pism [19][20][21][22],…”

“…A further indication is the investigation of pro longed erection differentiating high-flow and stasis pria pism [19][20][21][22],…”

Significance of the Intracavernosal Pharmacological Injection Test, Pharmacocavernosography, Artificial Erection and Cavernosometry in the Diagnosis of Venous Leakage

“…As part of this standardized procedure [8,28] the penis was carefully desinfected and the corpora cavernosa were punctured from sulcus coronarius. In order to control the position of the needle during puncturing, contrast medium was injected by means of a three-way faucet.…”

Optimierte Diagnostik der venösen Schwellkörperinsuffizienz (“Leakage”): Stellenwert von Papaverin-Test, Pharmakokavernosographie, artifizieller Erektion und Kavernosometrie

“…"Leakage" (28). In der Pharmakokavernosographie sollte dann ein persistierender venöser Abfluß in den Plexus santorinii radiologisch den venösen Schwellkörperabstrom dokumentieren (8,11,26). Die zur Induktion und Erhaltung einer Erektion ermittelten Flußraten (2,17,26) gelten als weitere relevante Kriterien, wobei nach Injektion vasoaktiver Substanzen die Amerikanische Gesellschaft für Impotenzforschung (Society for the Study of Impotence) derzeit für den Erhaltungsfluß 60 ml/min als Grenzwert für die Diagnose eines "Leakage" festlegt (9).…”