Variable response to intracavernous prostaglandin E1 testing for erectile dysfunction

Lehmann, Kurt; John, Hubert; Kacl, G. M.; Hauri, D.; Gasser, Thomas C.

doi:10.1016/s0090-4295(99)00260-5

Cited by 19 publications

(12 citation statements)

References 13 publications

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“…The most plausible explanation is that anxiety has a greater negative impact on the veno-occlusive mechanism than on the arterial response, due to a higher sensitivity of the latter to adrenergic input. 7 On basis of this pilot study, we conclude that a high dose of sildena®l may replace a single low dose ICI of the combination of papaverineaphentolamine as mode of stimulation during pharmaco-penile duplex scanning, yielding less false positive diagnoses of veno-occlusive dysfunction. The disadvantage of using sildena®l as mode of stimulation is the fact that the stimulation protocol is laborious and time-consuming because visual erotic stimulation has to be provided and the patient has to be dosed 1 h before PPDU.…”

Section: Discussionmentioning

confidence: 81%

The value of sildenafil as mode of stimulation in pharmaco-penile duplex ultrasonography

et al. 2001

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The purpose of this work was to assess whether a single intracavernous injection (ICI) of a low dose of the combination of papaverine ± phentolamine is replaceable by a high dose of the oral erectogenic agent sildena®l as mode of stimulation during pharmaco-penile duplex ultrasonography (PPDU). Eleven patients with complaints of erectile dysfunction were included in a crossover study. With an interval of two weeks the patients were exposed to ICI with papaverineaphentolamine (3.75 mga0.125 mg) and oral administration with sildena®l (100 mg) preceding PPDU. Five patients started with ICI. Six patients started with sildena®l. In the sildena®l stimulation mode, visual erotic stimulation (VES) was used to initiate erection. VES was applied by personal LCD monitor. Cut-off values to de®ne suf®cient arterial response were: peak¯ow velocity (PSV) b 25 cmas and acceleration time (AT)`72 ms. Cut-off value to de®ne suf®cient venoocclusion was a resistance index ! 1.00. Statistical analysis of PPDU parameters shows no signi®cant difference between the two modes of stimulation for arterial response (PSV, AT), whereas the resistance index, as a parameter of veno-occlusive response was signi®cantly higher in the sildena®l mode. This ®nding is con®rmed in the clinical translation of the results: two patients with an insuf®cient arterial response to ICI had a suf®cient arterial response to sildena®l and only one patient showed an insuf®cient arterial response following sildena®l, whereas the response following ICI was suf®cient. Analysis of veno-occlusive responses shows remarkable differences between both modes of stimulation. Whereas following the administration of sildena®l all veno-occlusive responses were classi®ed as suf®cient, seven patients showed an insuf®cient veno-occlusive response following ICI. As mode of stimulation in PPDU, high dose sildena®l yields signi®cantly less false positive diagnoses of`veno-occlusive dysfunction' than intracavernous injection of the combination papaverineaphentolamine. No difference was found in the quality of the arterial response. Based on this study we conclude that sildena®l may replace ICI as mode of stimulation during PPDU.

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Section: Discussionmentioning

confidence: 81%

The value of sildenafil as mode of stimulation in pharmaco-penile duplex ultrasonography

et al. 2001

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Section: Methodsmentioning

confidence: 99%

“…All patients of sample B underwent a provocative test with PGE 1 (10 mg); response was assessed after 20 min; responses were recorded on a four-point scale: 1 ¼ no response; 2 ¼ rigidity, insufficient for intercourse (o50%); 3 ¼ rigidity, sufficient for intercourse (450%); 4 ¼ full erection (490%) as previously described. 17 In addition, Structured interview on erectile dysfunction L Petrone et al because a normal PGE 1 responsiveness might be also present in patients with arteriogenic ED, 18,19 PDU examination was also performed before and after PGE 1 intracavernous injection (10 mg). A PGE 1 -induced cavernosal peak systolic velocity (PSV) Z30 cm/s was considered normal.…”

Section: Methodsmentioning

confidence: 99%

Structured interview on erectile dysfunction (SIEDY©): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction

et al. 2003

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The aim of the present study is the definition of a brief structured interview (SI) providing scores useful for identification and quantification of pathogenetic factors of erectile dysfunction (ED). A SI was developed and applied to a consecutive series of 320 ED patients. A 13-item SI, with threefactor analysis-derived scales, was identified and applied for validation to an independent consecutive series of 194 ED patients. PGE 1 (10 lg) intracavernosal injection, penile duplex ultrasound (PDU), blood hormones, PSA, glycemia, and lipids were used for the assessment of an organic component (OC), and Middlesex Hospital Questionnaire (MHQ) modified for psychological disturbances. Scale 1, dealing with OC, showed a positive correlation with age, BMI, blood pressure, glycemia, and inverse correlation, with testosterone, PGE 1 and several parameters derived from PDU. Scale 2, related to partner's relationship, was not correlated with organic parameters. Scale 3, which measures psychopathological traits was correlated with MHQ scales. Scale 1 (43) had a sensitivity of 67.9% and a specificity of 67.6% for OC. SIEDY r provides information on ED pathogenesis and might assist physicians in diagnostic and therapeutic choices. International Journal of Impotence Research (2003Research ( ) 15, 210-220. doi:10.1038 Keywords: erectile dysfunction; anamnesis; penile duplex ultrasound; structured interview IntroductionErectile dysfunction (ED) is a relatively common multidimensional disorder that might significantly impair the quality of life. Several biological, psychological and lifestyle factors are often simultaneously present in each patient and they mutually concur in determining the disorder. 1 The correct assessment of the pathogenesis of ED is therefore rather difficult. Complex diagnostic procedures, such as intracavernosal injection of PGE 1 with or without penile duplex ultrasound (PDU) evaluation of penile vessels, cavernosometry and cavernosography, and nocturnal penile tumescence, can be very useful in the definition of pathogenetic factors underlying ED. 2 However, these procedures are rather expensive and they are not easily available in all practices. Conversely, anamnesis and physical examination can provide information accurate enough for a correct pathogenetic definition in most cases. 3 The accuracy of anamnestic information depends upon the specific experience and interviewing skills of the individual physician. In current clinical practice, structured interviews (SIs) can represent a standardized and therefore more reliable instrument, when compared to routine anamnesis.Specific self-reported questionnaires have been developed for the assessment of severity of ED. Selfreported measures of severity of ED 4,5 are widely recognized as valid instruments and are routinely used for the evaluation of the efficacy of treatments. However, attempts to use self-reported questionnaires as a means of differentiating psychogenic from organic impotence have produced mixed results. In 1975, Beutler et al 6,7 reported th...

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“…All patients underwent a penile provocative test (FIC) with intracavernosal PGE 1 (10 mg); response was assessed after 20 min; responses were recorded on a four-point scale: 1 ¼ no response; 2 ¼ rigidity, insufficient for intercourse (o50%); 3 ¼ rigidity, sufficient for intercourse (450%); 4 ¼ full erection (490%) as previously described. 12 In addition, because a normal PGE 1 responsiveness might be also present in patients with arteriogenic ED, 13,14 penile duplex ultrasound examination (PDU) was performed before and after PGE 1 intracavernous injection (10 mg). The following parameters were considered: basal peak systolic velocity and acceleration, peak systolic velocity (VPS max ) and end diastolic velocity after PGE 1 intracavernous injection, resistance index.…”

Section: Methodsmentioning

confidence: 99%

Difficulties in achieving vs maintaining erection: organic, psychogenic and relational determinants

et al. 2005

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Achieving and maintaining a penile erection are two essential components of the male sexual response. It has recently been suggested that distinct molecular mechanism could underlie the two disturbances. The aim of the present study is to verify possible clinical differences on pathogenetic factors underlying difficulties of achieving and maintaining an erection. We studied a consecutive series of 560 patients (aged 51.9712.8 y old) reporting erectile dysfunction (ED), using SIEDY r structured interview. Patients were classified into two distinct categories: those with difficulties in maintaining, rather than achieving, an erection (sample A) and those with main problems in achieving an erection (sample B). A complete physical examination and a series of metabolic, biochemical, hormonal, psychometric, penile vascular tests and nocturnal penile tumescence and rigidity evaluations (NPT) were also performed. Sample B patients showed a higher prevalence of organic conditions related to ED, when compared with sample A as confirmed by higher SIEDY r scale 1 scores (3[1-5] vs 1[0.1-3] for sample B vs sample A, respectively; Po0.0001) which explores organic component of ED and higher prevalence of pathological instrumental parameters. No difference among groups was observed for SIEDY r scale 2 (relational component) and SIEDY r scale 3 (intrapsychic component) of ED. In conclusion, this study shows for the first time that patients with difficulties in maintaining erection are less likely to be affected by organic disturbances interfering with sexual function, when compared with those unable to achieve a valid erection.

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Variable response to intracavernous prostaglandin E1 testing for erectile dysfunction

Cited by 19 publications

References 13 publications

The value of sildenafil as mode of stimulation in pharmaco-penile duplex ultrasonography

The value of sildenafil as mode of stimulation in pharmaco-penile duplex ultrasonography

Structured interview on erectile dysfunction (SIEDY©): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction

Difficulties in achieving vs maintaining erection: organic, psychogenic and relational determinants

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