Consecutive nightly measurements are needed for accurate evaluation of nocturnal erectile capacity when the first-night laboratory recording is abnormal / 亚洲男科学杂志(英文版)

Multiple measurements of nocturnal penile tumescence and rigidity (NPTR) are widely accepted as a method to differentiate psychogenic erectile dysfunction (ED) from organic ED. However, direct evidence remains limited regarding the first-night effect on NPTR measurement using the RigiScan. Here, we evaluated the first-night effect on the results of NPTR measurement to validate the necessity of NPTR measurement for two consecutive nights, particularly when abnormal first-night measurements are recorded in a laboratory setting. We retrospectively reviewed 105 patients with a complaint of ED, who underwent NPTR measurement using the RigiScan in the Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-sen University (Guangzhou, China), for two consecutive nights, during the period from November 2015 to May 2016. NPTR parameters were collected and analyzed. We found that more effective nocturnal erections were detected during the second night than during the first night (P <0.001). Twenty percent of all patients had no effective erection during the first night, but exhibited at least one effective erection during the second night. The negative predictive value of NPTR measurement during the first night was 43.2%; this was significantly lower than that on the second night (84.2%; P = 0.003). Most NPTR parameters were better on the second night than on the first night. The first-night effect might be greater among patients younger than 40 years of age. In conclusion, two consecutive nightly measurements of NPTR can avoid a false-abnormal result caused by the first-night effect; moreover, these measurements more accurately reflect erectile capacity, especially when the first-night record is abnormal in a laboratory setting.

Consecutive nightly measurements are needed for accurate evaluation of nocturnal erectile capacity when the first-night laboratory recording is abnormal / 亚洲男科学杂志(英文版)

Multiple measurements of nocturnal penile tumescence and rigidity (NPTR) are widely accepted as a method to differentiate psychogenic erectile dysfunction (ED) from organic ED. However, direct evidence remains limited regarding the first-night effect on NPTR measurement using the RigiScan. Here, we evaluated the first-night effect on the results of NPTR measurement to validate the necessity of NPTR measurement for two consecutive nights, particularly when abnormal first-night measurements are recorded in a laboratory setting. We retrospectively reviewed 105 patients with a complaint of ED, who underwent NPTR measurement using the RigiScan in the Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun Yat-sen University (Guangzhou, China), for two consecutive nights, during the period from November 2015 to May 2016. NPTR parameters were collected and analyzed. We found that more effective nocturnal erections were detected during the second night than during the first night (P <0.001). Twenty percent of all patients had no effective erection during the first night, but exhibited at least one effective erection during the second night. The negative predictive value of NPTR measurement during the first night was 43.2%; this was significantly lower than that on the second night (84.2%; P = 0.003). Most NPTR parameters were better on the second night than on the first night. The first-night effect might be greater among patients younger than 40 years of age. In conclusion, two consecutive nightly measurements of NPTR can avoid a false-abnormal result caused by the first-night effect; moreover, these measurements more accurately reflect erectile capacity, especially when the first-night record is abnormal in a laboratory setting.

Application of nocturnal penile tumescence test in the diagnosis of erectile dysfunction / 中华男科学杂志

ED is a common male disease, often caused by neurological, vascular or psychological factors, and the diagnostic methods for ED vary widely. The nocturnal penile tumescence test (NPT) by RigiScan is an objective assessment method used mainly to detect ED and has gained a wide clinical application in recent years. This review focuses on the application value of the six RigiScan parameters in the diagnosis of ED, namely, the number of erections, total erection time, event rigidity of tip/base, event tumescence of tip/base, tumescence activated unit and rigidity activated unit, aiming to provide some help to clinicians and researchers with the application of NPT.

Penile erectile strength measurement band for differentiation and classification of erectile dysfunction / 中华男科学杂志

<p><b>Objective</b>To study the clinical application value of the penile erectile strength measurement (PESM) band in the differentiation of psychogenic from organic erectile dysfunction (ED).</p><p><b>METHODS</b>Eighty ED patients unable to achieve or maintain adequate penile erection to complete sexual intercourse were included in the experimental group and another 40 healthy subjects with normal erectile function enrolled as controls. The ED cases were classified into mild, moderate and severe ED according to the IIEF-5 scores and divided into psychogenic and organic ED based on the results of the nocturnal penile tumescence (NPT) test. Then all the subjects underwent a three-night continuous monitoring with the PESM band and, according to the band fracture rate, the ED cases were also classified into psychogenic and organic ED. The rates of missed diagnosis, misdiagnosis and diagnostic coincidence of PESM were calculated with the results of NPT as the standard for differentiating psychogenic from organic ED.</p><p><b>RESULTS</b>The results of NPT tests revealed 51 cases of psychogenic and 29 cases of organic ED in the experimental group. The band fracture rate in PESM was 95.0% in the mild, 80.9% in the moderate and 52.8% in the severe ED patients. Of the 51 cases of psychogenic ED detected by NPT test, 43 were diagnosed as psychogenic and the other 8 as organic ED with the PESM band, with a coincidence rate of 84.3%. Of the 29 cases of organic ED revealed by NPT test, 5 were diagnosed as psychogenic and the other 24 as organic ED by PESM, with a coincidence rate of 82.8%. Normal erectile function with three-level fracture of the band was observed in the PESM of the normal controls, which showed a coincidence rate of 100% with the results of NPT tests. Based on the standard of the NPT test, the rates of missed diagnosis, misdiagnosis and diagnostic coincidence of the PESM band in differentiating psychogenic from organic ED were 15.7%, 17.2%, and 83.8%, respectively, with a Kappa value of 0.656 (P <0.05).</p><p><b>CONCLUSIONS</b>The penile erectile strength measurement band can be used as a screening tool for initial differentiation of psychogenic from organic ED.</p>

Two Cases of Sleep-Related Painful Erection

Sleep-related painful erection (SRPE) is characterized by deep penile pain accompanied with erection occurring rapid eye movement (REM) movement period. Two (47-year-old and 40-year-old, respectively) male visited with the complaint of painful penile erection occurring during sleep. They had no problems with erection during daytime sexual activities except for mild premature ejaculation in one patient. Urologic inspections revealed no focal abnormalities. Polysomnography with simultaneous penile erection monitoring showed several episodes of awakening with painful erection which are time-locked to onset of REM sleep periods. According to the diagnostic criteria in international classification of sleep disorders, each patient was diagnosed to have chronic, severe SRPE. Despite of a low prevalence of SRPE, this condition should be considered in a patient who presents with nocturnal penile. A polysomnography accompanied with penile erection recording may help confirm diagnosis.

Correlation between metabolic syndrome and nocturnal penile tumescence test results / 中华泌尿外科杂志

Objective To investigate the correlation between nocturnal penile tumescence (NPT) test results and metabolic syndrome (MS).Methods In this prospective study,75 cases were enrolled,including 25 healthy volunteers (group A),25 erectile dysfunction (ED) patients with normal NPT results (group B),and 25 ED patients with abnormal NPT results (group C).At the time of recruitment,all the participants had serum total testosterone higher than 9.9 nmol/L,and were free of MS.At baseline,there was no significant differences in waistline,body mass index,fasting plasma glucose (FPG),mean arterial pressure (MAP),triglyceride,high density lipoprotein (HDL),cholesterol,and serum total testosterone among the three groups (P＞0.05).And there was no significant difference in international index of erectile function 5 score between group B and C.A follow-up survey was conducted three years after baseline to measure the above metabolic indicators and to compare the incidence of MS among the three groups.Results In the three-year follow-up survey,2 participants in group A were lost to follow-up,compared to 3 participants in group B and 5 participants in group C.In the three-year follow-up survey,there was no significant difference in all the indicators between group A and B; between group A and C,significant differences were observed in MAP,FPG,HDL,and cholesterol (P＜0.05); between group B and C,significant differences were observed in MAP and HDL (P＜0.05).In the three-year follow-up survey,2 participants in group A developed MS,compared to 3 MS patients in group B and 7 MS patients in group C.There was a significant difference in the incidence of MS among the three groups (P＜0.05).Conclusions To some extent,NPT reflects and predicts the development and progress of MS.Therefore,NPT can be used as an early indicator of MS.

Anestesia convencional e técnica de tumescência em cadelas submetidas à mastectomia. Avaliação da dor pós-operatória / Conventional anesthesia and tumescent technique in bitches which underwent mastectomy. Evaluation of postoperative pain

As neoplasias mamárias são as mais comuns em cadelas e geralmente acometem fêmeas de meia-idade a idosas, não castradas ou que foram submetidas ao procedimento de ovario-histerectomia tardiamente. A principal forma de tratamento é a excisão cirúrgica, sendo a ressecção unilateral das glândulas mamárias o procedimento mais realizado na prática veterinária. O objetivo do presente estudo foi comparar a dor pós-operatória em cadelas submetidas ao procedimento de mastectomia unilateral sob efeito das técnicas anestésicas de tumescência ou convencional. Foram utilizadas 20 cadelas, divididas em dois grupos: um grupo recebeu apenas a anestesia geral inalatória (grupo convencional), e o outro recebeu adicionalmente a anestesia infiltrativa por tumescência (grupo tumescência). Elas foram avaliadas nas primeiras 24 horas do período pós-operatório, e o processo álgico foi avaliado pela escala de dor da Universidade de Melbourne. As médias dos escores obtidos ao longo do tempo foram submetidas ao teste de Tukey a um nível de 5 por cento de significância (p<0,05). Não foram observadas diferenças significativas entre os grupos com relação à dor pós-operatória. A técnica anestésica infiltrativa por tumescência apresentou a vantagem da redução do sangramento transoperatório e mostrou-se exequível em pequenos animais, entretanto seu uso está relacionado à experiência e à preferência do cirurgião e do anestesista...

Mammary tumors are the most common neoplasm in bitches. Intact, mild to advanced aged female dogs are generally more affected. The main treatment is surgical excision and unilateral mastectomy is the most performed procedure in veterinary practice. The aim of this study was to compare the postoperative pain in dogs which underwent unilateral mastectomy and were anesthetized with tumescence and conventional anesthesia. Twenty bitches were randomly divided into two groups: Conventional Group (GC), which received only general inhalational anesthesia and Tumescence Group (GT), which also received tumescence anesthesia. All dogs were evaluated during the first 24 hours postoperatively. The scale of Pain from the University of Melbourne was used for the evaluation. The tukey test at a 5 percent level of significance (p <0.05) was used. There were no significant differences between groups related to postoperative pain. The technique of tumescent anesthesia reduced bleeding during surgery and is feasible in dogs. Its use is related to the surgeon and anesthesiologist's experience and preferences...

Evaluation of the Nervous and Vascular Systems in Erectile Dysfunction Patients after Electric Injuries / 대한비뇨기과학회지

PURPOSE: There is a high prevalence of erectile dysfunction (ED) after electric injuries, but our medical understanding of ED after electric injuries is scanty at best. Thus, the authors attempted to investigate nocturnal penile tumescence (NPT), bulbocavernosus reflex latency (BCRL) and penile duplex Doppler ultrasonography (PDDU) for the patients who suffer from ED after electric injuries. MATERIALS AND METHODS: Of the patients who visited our Burn Care Center between January 2005 and February 2006, ten male patients (aged 20 or older) who complaining of ED after electric injuries underwent NPT, BCRL and PDDU. RESULTS: The patients' mean age was 38.1 years (age range: 25-54), and the numbers of patients exposed to whole body, upper-lower extremity and upper-upper extremity pathways of the electrical current were 1, 2 and 7, respectively. For the patient exposed to the whole body pathway, abnormal findings were observed on all the tests. For one patient who experienced two upper-lower extremity pathways, normal findings were seen on all the tests, while the other patient showed an abnormal NPT, an normal BCRL and an arteriogenic ED. Three of the patients who experienced the upper-upper extremity pathway showed normal findings on all the tests. The other two in the group showed an abnormal NPT, a normal BCRL and arteriogenic ED; the other one showed a normal vascular function, a abnormal NPT and no reaction to BCRL; the other one showed an abnormal NPT, a delayed BCRL and an arteriogenic ED. CONCLUSIONS: More abnormal findings were seen in NPT, BCRL and PDDU for the cases associated with upper-lower body or whole body electrical current pathways, as compared to patients whose electrical pathways were limited to the upper body.

Significance of Polysomnographic Nocturnal Penile Tumescence Monitoring in the Diagnosis of Erectile Impotence / 대한비뇨기과학회지

Nocturnal penile tumescence has been proposed as a source of objective data in the evaluation of erectile capacity and clinically important in differentiating between psychogenic and organic impotence. However, the absence of sleep information and difficult differentiation of movement artifact leads to false positive or false negative reaction when portable home monitor is used. This can be overcome by polysomnographic monitoring. In addition, sleep disorders affecting nocturnal penile tumescence also could be screened. Herein, we conducted a study to investigate the significance of polysomnographic nocturnal penile tumescence monitoring in 45 men with erectile dysfunction. The nocturnal penile tumescence data from polysomnographic method were compared with those from portable method, based on the results from standard method. The results obtained were summarized 1. Polysomnographic method showed higher sensitivity(82%), lower false positive(20%) and false negative rate(16%) than portable method (71%, 30%, 28%, respectively) in the differential diagnosis of impotence. 2. Among 10 patients, with measuring of air flow monitoring and anterior tibialis EMG one patient had periodic leg movement. 3. Statistically, parameters of total REM time, total tumescence time/total sleep time, number of maximum tumescence episodes, amount of maximum tumescence episodes, T-up and T-max phase in maximum tumescence episodes, circumferential changes in maximum tumescence episodes, and rigidity in maximum tumescence episodes were found to be significantly decreased in organic impotence group. These results reflect that polysomnographic NPTM provides more validity than portable NPTM on the outcome of the differential diagnosis of impotence, and it would contribute to screening of occult sleep disorders and to study for their characteristics in association with impotence.

Significance of Nocturnal Penile Tumescence in the Differential Diagnosis of Sexual Impotence / 대한비뇨기과학회지

Nocturnal penile tumescence is very importent in differential diagnosis between psychogenic and organic impotence. NPT was assessed in 37 impotent patients and 8 normal potent patients. There was no discrepancy between psychogenic and control group, but some 4 case had slight reduced NPT. In all organic cases, the figures of frequency, degree and duration of NPT was significantly reduced. This method is not definite to differentiate impotent: 27% of psychogenic importent patients have reduced NPT. We use some complementary diagnostic tool to diagnose organic impotence: routine lab, snap gauge test, PDI, erection penogram, BCRL and SEP, hormonal test and MMPI etc. This method is useful to differentiate impotence, when used with other complementary method. It is promising, but further study is needed.

Polysomnographic Nocturnal Penile Tumescence Monitoring / 대한비뇨기과학회지

Nocturnal penile tumescence is a well-documented normal occurrence associated with rapid eye movement sleep and clinically important in differentiating between psychogenic and organic impotence. The failure, however, to differentiate true increases in tumescence from movement artifact would lead to overestimation of NPT magnitude when portable home-monitoring is used. This can be overcome only by monitoring sleep polygraphically including electroencephalography, electooculography and electromyography. Recently, polysomnographic NPT testing was undertaken in normal potent men and in patients with erectile impotence, which suegests its clinical applicability in diagnosis of erectile impotence and possibly contributes toward understanding the characteristics of penile erection. Herein, we introduce our initial experience of polysomnographic NPTM including methodology, advantages and disadvantages with some literature.

Erectile dysfunction detection by the nocturnal penile tumescence testing / 中国法医学杂志

Objective To solve the problem of erectile dysfunction in clinical forensic medicine investigation by using the nocturnal penile tumescence (NPT) testing. Method 13 cases who complained erectile dysfunction after trauma were studied by using RIGISCAN PLUS SYSTEM. Results In 13 cases, the results of NPT testing showed that the erectile function was normal in 3 cases, slight dropping in 5 cases, medium dropping in 2 cases, and completely losing in 3 cases. In 5 cases which were serious erectile dysfunction as tested by IIEF, the NPT showed that the erectile function was normal in 1 case, slight dropping in 1 case, medium dropping in 1 cases, and losing completely in 2 cases. Conclusion The nocturnal penile tumescence testing can solve the problem of erectile dysfunction in forensic medicine investigation including the estimatieon of the severity of injury, labor ability assessment and some related questions.

Applicable Value of the Nocturnal Penile Tumescence Test In the Judgement of Erectile Dysfunction after Trauma / 中国法医学杂志

0.05 ). Conclusion The NPT test is simple and practical, and its diagnostic accuracy is comparable to that of the combined test. The NPT test should be used as an examination of choice for the primary etiological diagnosis in ED after trauma.

Clinical Significance of Nocturnal Penile Tumescence Monitoring with Stamps / 대한비뇨기과학회지

This study was conducted in order to investigate the clinical significance of nocturnal penile tumescence recording with stamps. The results were as follows; 1. In the study of 33 normal potent men, 96 stamp tests were undertaken. Among them, stamp breakage occurred in 62 trials (64.6%) and in remaining 34 trials (35.4%) stamp breakage failed to occur. 2. In 30 (90.0%) of the 33 normal potent cases, showed one or more incidence of stamp breakage and was considered as a positive response and in the remaining 3 cases (9.1%) showed no stamp breakage at all in a three consecutive trials. 3. In 8 patients complaining impotence after urethral injury, showed no breakage of stamp at all in a consecutive 42 trials (100% negative response).

Nocturnal Penile Tumescence Monitoring with Stamps / 대한비뇨기과학회지

Nocturnal penile tumescence monitoring has gained wide acceptance in differential diagnosis of impotence. We developed a modified stamp technique which use a strip of stamps, each 2.2cm by 2.5cm, and the vinyl plaster for snugger wrapping and sealing of stamps around the penile shaft. This is a simple, time-saving and useful screening test for organic impotence.