DIAGNOSIS OF IMPOTENCE

To diagnose the venous impotence, we performed a dynamic cavernography on 103patients with impotence. Almost all of them also underwent an erectilc function test with NPT an/or AVSS, a PBl calculation and a papaverine test. The results were as follows.<br>1) In theree patients out of the 103 the test was terminated bccause of chest pain or discomfort in the penis. In llpatients out of the remaining 100, intracavernous infusion till 200ml/min failcd to produce an erection. In the remaining 89, satisfactory erections were achieved at flow rates of between 40 to 200ml/min and were maintained at 5 to 160ml/min.<br>2) In 20 patients out of 98, a cavernography did not visualize any venous systcm after ercction, but did in the remaining 78. The average flow rate to produce and to maintain an erection in the former was significantly lower than the latter (Fig. 1). Because the veins were apparent not only in patients with high flow rates but also in men with low flow rates, the findings of cavernography alone were not useful for diagnosis of venous impotence, but could reveal the location of venous abnormalities.<br>3) The patients who were evaluated as functional impotent by an erectile function test had lower flow rates than those who were evaluated as organic impotent (Fig. 2, 3).<br>4) The flow rates of the patients who achieved satisfactory erection by intracavernous papaverine injection were sign4fficantly (p<0.001) lower than that of those who did not (Fig. 4, 5). The aecragc flwo rate and standard deviation to produce and maintain erection in the former were 80.8±29.25ml/min and 21.9±15.02ml/min, respcctivcy. We calculated the normal flow rates [NFR<(avcrage flow rate+2SD)] using these results. The normal flow rate to produce an erection was less than 140ml/min, and that to maintain it was less than 50ml/min. In 41 men out of 100, the flow rate to produce and/or to maintain were beyond the normal range, and we diagnosed them as venous impotent.<br>5) No correlation was seen between the findings of dynamic cavernography and the results of PBl calculation.