Pharmacoangiographic assessment of the corpora cavernosa

The present section presents further observations regarding cavernosometry and cavernosography, emphasizing the value of intracavernosal injection of a papaverine-phentolamine combination. Subsequent pharmacocavernosometry during fluid infusion then enables (1) precise quantitation of cavernosal leak by the pharmacologic maintenance erection flow (PMEF) method, and (2) determination of cavernosal pressure pulsations, a useful reflection of arterial sufficiency. In patients with excessive cavernosal leak, pharmacocavernosography supplements the examination by indicating the routes of persistent major venous drainage, key information in planning venoablative therapy. Compared with nonpharmacologic methods for cavernosometry and cavernosography, we feel the pharmacologic technique offers the following advantages: (1) it enables the highly accurate and reproducible PMEF method for quantitating cavernosal leakage; (2) the sites of abnormal leakage can be evaluated by cavernosography only after the pharmacologic technique; (3) the infusion volumes required to produce erection are smaller, more physiologic, and more conveniently administered; (4) the amplitude of the cavernosal pressure pulsation becomes useful as an index of arterial sufficiency; and (5) pulsations of the dorsal penile artery are amplified to the point of easy palpability, or more reliable Doppler detection.