The erectile angle: objective criterion to evaluate the papaverine test in impotence

Intracavernous papaverine injection may be the first diagnostic step in the assessment of the impotent patient. However, the appreciation of its effect must rely on the evaluation of penile rigidity. Since measurement of rigidity requires a sophisticated procedure that may not be available to the majority of practitioners, we attempted to find a simple and objective method to evaluate the results of this common test. We tested 50 patients complaining of impotence with intracavernous injection of 60 mg. papaverine. The length and circumference of the penis were measured before and after papaverine injection. The rigidity was determined by measuring the angle between the penis and the legs with the patient in the standing position. Afterwards, each patient underwent vascular (Doppler ultrasound and cavernometry) and neurological examinations. A total of 27 patients with no vascular abnormalities had an erectile angle of 96 degrees (range 90 to 130 degrees), while 23 patients had some vascular disorders (9 arterial lesions, 8 venous leakage and 6 combined lesions) and an erectile angle of 36 degrees (range 0 to 60 degrees). There was no significant difference between the groups in the increase of length and circumference of the penis after intracavernous injection of papaverine. The papaverine test can distinguish between patients with vascular and psychogenic problems. A negative papaverine test associated with a normal Doppler examination is characteristic of venous leakage. Measurement of the erectile angle after intracavernous injection of papaverine with the patient in the standing position is a simple, objective and reliable method to evaluate patients with vascular impotence.