Causes of erectile dysfunction after spinal or pelvic injuries / 中华泌尿外科杂志

Objective To assess the causes of erectile dysfunction (ED) after spinal or pelvic injuries.Methods From 2005 to 2009,a total of 67 patients who complained of ED after pelvic fracture or spinal injures were evaluated with the average patient age of 32 yrs (18 to 64) and average injury period of 38 mon (3 -144).Of the 67 patients,56 had pelvic fractures (84％) and 11 patients had spinal injures ( 16％ ).All patients reported normal erectile function before the injuries.All patients answered IIEF-5 and underwent nocturnal penile tumescence (NPT) tests (Rigiscan assessment system,continuing three nights).If resuls of the test were abnormal,color penile duplex ultrasound ( CDU ) with intracavernous injection were performed.Normal nocturnal erectile function was defined as at least three tumescence periods lasting more the 10 minutes with rigidity at the penile tip of at least 70％.Patients with abnormal nocturnal erectile function were diagnosed with organic ED.Patients who achieved a fully erect penis after intracavernous injection,and who had a peak systolic velocity ( PSV ) of less than 25 em/s on CDU were diagnosed with arterial ED.Patients with a PSV of more than 25 cm/s and an end diastolic velocity (EDV) of more than 5 cm/s on CDU indicated venous leakage.Patients with organic ED who had normal vascular function on duplex ultrasound were diagnosed with neurogenic ED.Results All patients reported IIEF-5 less than 8,NPT tests showed that all patients had organic ED.Of the patients with pelvic fracture,neurogenic ED,arterial ED and venous leakage was diagnosed in 24 patients (43％),22 patients (39％) and 10 patients (18％),respectively.However,the patients with spinal injuries were all diagnosed with neurogenic ED.Conclusions Pelvic fracture and spinal injury can cause organic ED.Vascular ED is common in pelvic fracture,however,neurogenic ED was the most common type of ED in spinal injury.

Color Doppler sonographic evaluation in 32 patients with venous leakage in venous incompetence in erectile dysfunction / 中华泌尿外科杂志

Objective To investigate the hemodynamic change of venous leakage in venogenic impotence. Methods Thirty-two patients with vasculogenic impotence were evaluated with conventional penile duplex sonography with spectral analysis and color Doppler imaging after intracavernosal injection of PGE1 to induce an erection.The color Doppler appearance of deep dorsal vein of penis,cavernous veins and bulbourethral vein wen observed and the correlativity with resistance index(RI)of cavernous artery were analyzed. Results After five minutes following intracavernous injection,the flow and diameter of the penis vein were continuous increased.The coefficient correlation r between the discharge of deep dorsal vein of penis,cavernous veins and bulbourethral vein with RI of cavernous artery were-0.55,-0.53,-0.24(P＜0.05).Considering the existence of mixed venous leakage,r between the discharge of vein of penis with RI of cavernous artery was-0.88(P＜0.001).Conclusions Higher qualitative ultrasound imaging could demonstrate venous leakage sensitively and assess the location and degree of venous leakage in venogenic impotence initially.

Improving the Accuracy of Hemodynamics Using a Vasoactive Medication Re-dosing during Dynamic Infusion Cavernosometry and Cavernosography / 대한비뇨기과학회지

PURPOSE: Dynamic infusion cavernosometry and cavernosography (DICC) is a recognized technique for evaluating the hemodynamics of an erection. During DICC, complete corporeal smooth muscle relaxation is essential for obtaining accurate data. A means of promoting maximal smooth muscle relaxation is repeat doses of vasoactive medication during vascular testing. The effect of re-dosing with vasoactive medication on the hemodynamics was investigated in impotent men undergoing DICC. MATERIALS AND METHODS: A total of 81 patients having undergone DICC, between January 2002 and December 2003, were prospectively reviewed. When the veno-occlusive parameters were abnormal, the intracavernous vasoactive agent dose was repeated a maximum of 3 times. Arterial insufficiency was diagnosed when the cavernosal artery systolic occlusion pressure was less than 100mmHg or more than 30mmHg below brachial arterial pressure. Venous leakage was diagnosed when the flow-to- maintain value was greater than 3ml/min or the pressure decay was greater than 45mmHg/30sec. The proportion of men in whom the vascular diagnosis had altered was analyzed using this regimen. RESULTS: Of the 81 subjects, 69 (85.2%) warranted re-dosing based on their abnormal veno-occlusive parameter. Of these 69 patients, the veno- occlusive values were corrected in 22 (31.9%) by repeat medication; therefore, they would have been falsely diagnosed with venous leakage during vascular evaluation. 13 patients (59.1%) of all corrections occurred with the second dose, while 9 patients (40.9%) of the patients required a third dose of medication. CONCLUSIONS: Re-dosing with a vasoactive agent should be considered during vascular evaluation where incomplete corporeal smooth muscle relaxation is suspected. This approach increases the likelihood of a more accurate diagnosis and decreases the risk of a false diagnosis of venous leakage.

Evaluation of Cavernosography Diagnosis of Venous Leakage Impotence(An Analysis of 25 Cases) / 实用放射学杂志

Objective To study the diagnostic value of cavernosography in the venous leakage impotence.Methods Cavernosography were performed for 25 patients with the venous leakage impotence who had been diagnosed by the clinic just after the contrast agent had been injected.The appearance of cavernosography were analysed.Results Different degree venous leakage had been shown in 25 cases.The diagnostic accordance rate of the cavernosography,clinic impotence for the venous leakage was 100%(25/25).The accordance rate of the degree of the venous leakage shown by the cavernosography and pointed out by the clinical impotence was 36%(9/25).Conclusion Cavernosography not only can show the venous leakage and its location,but also can know the degree of the venous leakage.

A Comparative Study Between Shield Assembly and Bedstead in Cavernosography ofVenous Leakage Impotence / 实用放射学杂志

Objective To study the diagnostic techniques,radiographic manifestations and diagnostic value of the venous leakage impotence.Methods Radiographies were performed in the shield assembly for 25 patients with the venous leakage impotence who had been diagnosed by the clinic just after the contrast agent had been injected.The radiographic appearances and operation were analysed and compared with another 25 patients whose radiographies were performed by bedstead.Results Venous leakage of diffrent drgree was shown in 25 cases.The diagnostic accordance rate of the clinic impotence,cavernosa trial and the cavernosagraphy for the venous leakage was 100%(25/25).The accordance rate of the degree of the venous leakage between the cavernosa trial and cavernosagraphy was 60%(15/25),the clinical impotence and cavernosa trial was 52%(13/25),the clinical impotence and the cavernosagraphy was 36%(9/25),the clinical impotence,cavernosa trial and the cavernosagraphy was 32%(8/25).The results had no obvious distinct between two groups.Conclusion Just after the contrast agent was injected in the shield assembly,the radiographies of the cavernosography not only can show the venous leakage and its location,but also can know the degree of the venous leakage.The radiation absorbed dose of the medical personnel has been greatly reduced.