Penile pharmacotesting (PPT) with alprostadil (PGE(1)) represents the most common diagnostic approach to male erectile dysfunction (ED). A positive response - i.e. normal erectile rigidity of sustained duration - is presumed to exclude venous or arterial pathology with enough accuracy. To test this assumption we compared PPT vs. flowmetric results obtained by colour-duplex Doppler ultrasound (CDDU) in patients (pts) undergoing diagnostic evaluation for ED under conditions of maximal cavernous relaxation. A total of 195 non-consecutive impotent pts were diagnosed after dynamic CDDU as non-vasculogenic (NOR), or having arteriogenic (AR), veno-occlusive (VO) or mixed (MX) ED. Maximal erection obtained after PPT was scored as: type-1 (full tumescence - no sustained rigidity, angle on the abdominal plane >90degrees), type-2 (sustained partial erection, valid for intromission, angle = 90degrees) and type-3 (sustained full erection, angle <90&DEG;). Comparing PPT with flowmetric results, we found that a type-3 response had 20% false negative diagnosis of NOR (17% of AR- and 3% of VO- and MX-ED, respectively), while a type-2 response had 63% false negative diagnosis (20% of AR, 37% of VO- and 6% MX-ED, respectively). Type-1 response was associated with the presence of VO dysfunction in 99%, of cases. These data suggest that a positive response to PPT (type-2 and type-3) assessed by the visual rating of erection is associated with both arterial (up to 20%) and/or VO (up to 43%) ED. as detected by CDDU. We conclude that PPT alone is a misleading diagnostic test to exclude vascular ED and that dynamic CDDU should be offered to pts investigated for male ED.

Penile pharmacotesting in diagnosing male erectile dysfunction: evidence for lack of accuracy and specificity / Antonio, Aversa; Isidori, Andrea; Massimiliano, Caprio; Marco, Cerilli; Vanni, Frajese; Andrea, Fabbri. - In: INTERNATIONAL JOURNAL OF ANDROLOGY. - ISSN 0105-6263. - STAMPA. - 25:1(2002), pp. 6-10. [10.1046/j.1365-2605.2002.00314.x]

Penile pharmacotesting in diagnosing male erectile dysfunction: evidence for lack of accuracy and specificity

ISIDORI, Andrea;
2002

Abstract

Penile pharmacotesting (PPT) with alprostadil (PGE(1)) represents the most common diagnostic approach to male erectile dysfunction (ED). A positive response - i.e. normal erectile rigidity of sustained duration - is presumed to exclude venous or arterial pathology with enough accuracy. To test this assumption we compared PPT vs. flowmetric results obtained by colour-duplex Doppler ultrasound (CDDU) in patients (pts) undergoing diagnostic evaluation for ED under conditions of maximal cavernous relaxation. A total of 195 non-consecutive impotent pts were diagnosed after dynamic CDDU as non-vasculogenic (NOR), or having arteriogenic (AR), veno-occlusive (VO) or mixed (MX) ED. Maximal erection obtained after PPT was scored as: type-1 (full tumescence - no sustained rigidity, angle on the abdominal plane >90degrees), type-2 (sustained partial erection, valid for intromission, angle = 90degrees) and type-3 (sustained full erection, angle <90&DEG;). Comparing PPT with flowmetric results, we found that a type-3 response had 20% false negative diagnosis of NOR (17% of AR- and 3% of VO- and MX-ED, respectively), while a type-2 response had 63% false negative diagnosis (20% of AR, 37% of VO- and 6% MX-ED, respectively). Type-1 response was associated with the presence of VO dysfunction in 99%, of cases. These data suggest that a positive response to PPT (type-2 and type-3) assessed by the visual rating of erection is associated with both arterial (up to 20%) and/or VO (up to 43%) ED. as detected by CDDU. We conclude that PPT alone is a misleading diagnostic test to exclude vascular ED and that dynamic CDDU should be offered to pts investigated for male ED.
2002
arteriogenic; duplex ultrasound; erection; pge 1; pge(1); veno-occlusive
01 Pubblicazione su rivista::01a Articolo in rivista
Penile pharmacotesting in diagnosing male erectile dysfunction: evidence for lack of accuracy and specificity / Antonio, Aversa; Isidori, Andrea; Massimiliano, Caprio; Marco, Cerilli; Vanni, Frajese; Andrea, Fabbri. - In: INTERNATIONAL JOURNAL OF ANDROLOGY. - ISSN 0105-6263. - STAMPA. - 25:1(2002), pp. 6-10. [10.1046/j.1365-2605.2002.00314.x]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/138392
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