Dynamic pharmacocavernosometry: a search for an ideal approach

Of 141 patients attending the department with complaints of erectile dysfunction, 57 were diagnosed as having organic impotence. Of these 57 patients, 37 were found to have venogenic impotence. All 37 patients had normal Duplex Doppler ultrasound examination and nonvasculogenic factors were ruled out. Corporovenous leak (CVL) was diagnosed on careful workup of dynamic pharmacocavernosometry along with cavernosography. After giving 60 mg of papaverine intracavernosally, dynamic cavernosometry was performed on a Dantec 5000 Urodynamic machine. The vesical or abdominal pressure was taken as intracavernous pressure (ICP) and venous infusion as total intracavernosal flow, measured on a Special User Program. The pressure and maintenance flow criteria were used to diagnose CVL and to define the correlation. Concomitant cavernosography was performed in each case to have radiological evidence. The criteria used to define the leak were: (1) maintenance flow requirement of > or = 30 ml/min, and (2) a fall in ICP of > 40 cm/30 s after achieving full erection when flow is stopped. Apart from these 37 patients, 5 normal controls and 7 patients with psychogenic impotence were also evaluated by this method to establish normal criteria.