[Study and treatment of erection disorders. Value of intracavernous injections]

A multidisciplinary study of 57 patients with erection disorders included in addition to standard examinations: clinical, hormonal, vascular using Doppler and nervous with determination of latency time of bulbocavernous reflex, evaluation of effects of intracavernous papaverine injections completed by a manometric study of cavernous body filing by perfusion. A clear positive result of the papaverine test is considered to reflect integrity of vascularization of corpus cavernosum structure, and renders value less the continuation of vascular investigations. The appearance of an almost normal but delayed erection requiring high-dose papaverine administration is interpreted as being due to insufficiency of arterial origin without anomaly of venous return. The absence of erection after papaverine injection, whether in the presence or absence of an increase in penis volume, results from excessive venous return, insufficient arterial supply or both. Absence of erection despite a cavernous perfusion of more than 70 ml/min is due to excessive venous return that requires localization by cavernography. The onset of erection during cavernous body filling eliminates excessive venous return and results from arterial insufficiency that necessitates pelvic arteriography. A therapeutic attitude of logical consequence is proposed.