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A screening sequence for vasculogenic impotence.

R G DePalma, H A Emsellem, C M Edwards

    Journal of Vascular Surgery
    |February 1, 1987
    PubMed
    Summary
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    Identifying the causes of erectile dysfunction (ED) is key for treatment. This study found abnormal penile blood flow linked to smoking and large vessel disease, while neurological issues were also common in impotent men.

    Area of Science:

    • Urology
    • Vascular Surgery
    • Neurology

    Background:

    • Penile erectile failure requires precise diagnosis for effective surgical intervention.
    • Identifying specific neural, arterial, and venous contributions is crucial, especially in men with impotence as the sole sign of pelvic arterial disease.

    Purpose of the Study:

    • To delineate the neural, arterial, and venous components of erectile dysfunction.
    • To establish a diagnostic sequence for patient selection in surgical interventions for impotence.

    Main Methods:

    • Noninvasive penile perfusion estimates (pulse volume recording, penile/brachial blood pressure indices).
    • Evoked potentials (somatosensory evoked potentials, bulbocavernosus reflex time).
    • Pharmacological testing (papverine-induced artificial erection) and selective arteriography/cavernosography.

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    Main Results:

    • Abnormal penile blood perfusion significantly correlated with smoking and overt large vessel disease.
    • Covert neurological abnormalities were detected in a substantial portion of impotent men.
    • Combined abnormal perfusion and failed artificial erection predicted specific arterial diseases.

    Conclusions:

    • A comprehensive diagnostic approach is essential for understanding erectile dysfunction.
    • Smoking and vascular disease are key contributors to impaired penile perfusion.
    • Neurological deficits and specific arterial pathologies require targeted investigation.