Guidelines for the assessment of the vasculogenig erectile dysfunction

The diagnosis of erectile dysfunction (ED) is a clinical diagnosis that should be made by an andrologist – urolo- gist – sexologist. History and physical examination should always be done before laboratory investigatioms. History should be medical and psychological. Many common diseases are associated with ED, such as arte- rial hypertension, diabetes mellitus, myocardial diseases, lipoidoproteinoses - hypercholesterolemia, renal insuffi- ciency, hypogenitalism, neurological diseases, psychiatric diseases, previous rectal and vascular, genital/urinary oper- ations, anti-hypertension and psychotropic drugs, alcohol abuse, marijuana, codeine, meperidine, methadone and heroin, previous radiotherapy. Physical examination should always be performed on every patient, particularly assessing the endocrine, vascu- lar, neurological and genital/urinary tract.1, 2 Several blood laboratory tests are recommended (gly- caemia and testosterone in most patients; lipidic profile, prolactinemia, and PSA may be required based on the physical examination.3-5 Color-coded duplex scanning (CDS) — Penile tumescence test — Spontaneous nocturnal tumescence − Visual sexual stimulation tumescence — Standard radiography (Xray) — Dynamic cavernous measurement (perfusion pres- sure, venous return, diameter changes of cavernous body) — Digital subtraction angiography (DSA) Complementary investigations — Neurological assessment — Electromyography of the sphincters — Electromyography of the cavernous bodies — Cortical evoked potentials from dorsal nerve of the penis Erection drug test without CDS, since it does not pro- vide aetiological indications in the non-responder patient