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.

Effect of prolactin on penile erection: A cross-sectional study / 亚洲男科学杂志(英文版)

Although elevated prolactin levels have been shown to inhibit penile erection, the relationship between prolactin and erection of the penile tip or base has not been extensively researched. We therefore investigated the prolactin's effects on erection of the penile tip and base, with a cross-sectional study of 135 patients with erectile dysfunction, based on scores of ≤21 on the International Index of Erectile Function-5. All patients were tested for nocturnal penile tumescence, blood pressure, serum glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol, testosterone, and progesterone. Univariate and multivariate analyses were used to assess the associations between prolactin levels and erection at the penile tip and base. We found no obvious relationship between erection time at penile tip and prolactin levels, but observed a negative correlation between base erection time and prolactin level (hazard ratio: -2.68; 95% confidence interval [CI]: -5.13 - 0.22). With increasing prolactin concentration, multivariate analysis showed obvious reduction in base erection time among patients with normal Rigiscan results (hazard ratio: -3.10; 95% CI: -7.96-1.77; P < 0.05). Our data indicate that prolactin inhibits penile erection, particularly at the penile base. In addition, when the effective erection time of the penile base lasts longer than 10 min, prolactin has a more obvious inhibitory effect on penile base erection.

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.

Effect of prolactin on penile erection: a cross-sectional study / 亚洲男科学杂志(英文版)

Although elevated prolactin levels have been shown to inhibit penile erection, the relationship between prolactin and erection of the penile tip or base has not been extensively researched. We therefore investigated the prolactin's effects on erection of the penile tip and base, with a cross-sectional study of 135 patients with erectile dysfunction, based on scores of ≤21 on the International Index of Erectile Function-5. All patients were tested for nocturnal penile tumescence, blood pressure, serum glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, luteinizing hormone, follicle-stimulating hormone, prolactin, estradiol, testosterone, and progesterone. Univariate and multivariate analyses were used to assess the associations between prolactin levels and erection at the penile tip and base. We found no obvious relationship between erection time at penile tip and prolactin levels, but observed a negative correlation between base erection time and prolactin level (hazard ratio: -2.68; 95% confidence interval [CI]: -5.13--0.22). With increasing prolactin concentration, multivariate analysis showed obvious reduction in base erection time among patients with normal Rigiscan results (hazard ratio: -3.10; 95% CI: -7.96-1.77; P < 0.05). Our data indicate that prolactin inhibits penile erection, particularly at the penile base. In addition, when the effective erection time of the penile base lasts longer than 10 min, prolactin has a more obvious inhibitory effect on penile base erection.

Audiovisual Sexual Stimulation and RigiScan Test for the Diagnosis of Erectile Dysfunction / 中华医学杂志(英文版)

<p><b>Background</b>Currently available evaluation criteria for penile tumescence and rigidity have been fraught with controversy. In this study, we sought to establish normative Chinese evaluation criteria for penile tumescence and rigidity by utilizing audiovisual sexual stimulation and RigiScan™ test (AVSS-Rigiscan test) with the administration of phosphodiesterase-5 inhibitor.</p><p><b>Methods</b>A total of 1169 patients (aged 18-67 years) complained of erectile dysfunction (ED) underwent AVSS-RigiScan test with the administration of phosphodiesterase-5 inhibitor. A total of 1078 patients whose final etiological diagnosis was accurate by means of history, endocrine, vascular, and neurological diagnosis, International Index of Erectile Function 5 questionnaire, and erection hardness score were included in the research. Logistic regression model and receiver operating characteristic curve analysis were performed to determine the cutoff value of the RigiScan™ data. Then, the multivariable logistic analysis was used in the selected variables.</p><p><b>Results</b>A normal result is defined as one erection with basal rigidity over 60% sustained for at least 8.75 min, average event rigidity of tip at least 43.5% and base at least 50.5%, average maximum rigidity of tip at least 62.5% and base at least 67.5%, △tumescence (increase of tumescence or maximum-minimum tumescence) of tip at least 1.75 cm and base at least 1.95 cm, total tumescence time at least 29.75 min, and times of total tumescence at least once. Most importantly, basal rigidity over 60% sustained for at least 8.75 min, average event rigidity of tip at least 43.5%, and base at least 50.5% would be the new normative Chinese evaluation criteria for penile tumescence and rigidity. By multivariable logistic regression analysis, six significant RigiScan™ parameters including times of total tumescence, duration of erectile episodes over 60%, average event rigidity of tip, △tumescence of tip, average event rigidity of base, and △tumescence of base contribute to the risk model of ED. In logistic regression equation, predict value P < 0.303 was considered as psychogenic ED. The sensitivity and specificity of the AVSS-RigiScan test with the administration of phosphodiesterase-5 inhibitor in discriminating psychogenic from organic ED was 87.7% and 93.4%, respectively.</p><p><b>Conclusions</b>This study suggests that AVSS-RigiScan test with oral phosphodiesterase-5 inhibitors can objectively assess penile tumescence and rigidity and seems to be a better modality in differentiating psychogenic from organic ED. However, due to the limited sample size, bias cannot be totally excluded.</p>

Nocturnal Penile Tumescense and Rigidity Testing for Evaluation of Erectile Dysfunction in Men with Spinal Cord Injury

OBJECTIVE: To evaluate erectile dysfunction in patients with spinal cord injury and the relationship between patient's subjective answers and the results of objective tests regarding erectile dysfunction. METHOD: Twenty-one male patients with erectile dysfunction after spinal cord injury were administered with nocturnal penile tumescense and rigidity testing (NPTR) using Rigiscan(R) over 2 consecutive nights. NPTR using Rigiscan(R) at second night was performed after oral administration of sildenafil 50 mg. Answer of the global efficacy question (GEQ) after oral administration of sildenafil 50 mg and the parameters of NPTR were compared. RESULTS: After oral administration of sildenafil 50 mg, number and duration of erectile episodes, and duration of rigidity greater than 60% on NPTR improved significantly (p< 0.05). Sixteen out of seventeen patients (94.1%) who showed improved nocturnal erection after oral administration of sildenafil 50 mg answered that they had an improved erectile function after sildenafil. All four patients (100%) who showed no improvement in nocturnal erection after sildenafil answered that their erectile function was not improved after oral administration of sildenafil 50 mg. CONCLUSION: We expect NPTR using Rigiscan(R) might be useful for the evaluation of erectile dysfunction in men with spinal cord injury.

Is There a Role of RigiScan(R) in the Measurement of Rigidity after Intracorporeal Injection of Prostaglandin E1? / 대한비뇨기과학회지

PURPOSE: To evaluate whether radial rigidity measured using RigiScan(R) represents the intracorporeal pressure effectively. MATERIALS AND METHODS: From January 1998 to May 1999, total of 23 patients with erectile dysfunction were evaluated by RigiScan(R) and duplex ultrasonography after the intracorporeal injection of prostaglandin E1. Peak systolic velocity and end diastolic velocity were measured by duplex ultrasonography and then the resistance index was calculated as (peak systolic velocity-end diastolic velocity)/(peak systolic velocity). Radial rigidity of penile tip and base was measured by RigiScanR . The results were analyzed statistically by PC-SPSS version 7.5. RESULTS: There were statistically significant correlations between radial rigidity of penile tip and base and the resistance index by Spearman's correlation analysis, respectively (r=0.680, p<0.001)(r=0.703, p<0.001). When radial rigidity of penile tip and base exceeded 60% of maximum, radial rigidity of penile tip and base again correlated well with the resistance index, respectively (r=0.659, p=0.020)(r=0.759, p=0.011). Based on clinically determined degree of erection, radial rigidity of penile tip and base represented the intracorporeal pressure effectively. CONCLUSIONS: Radial rigidity measured by RigiScan(R) represents the intracorporeal pressure effectively.

The Usefulness of RigiScan(R) as Screening Test for Duplex Ultrasonography after Intracorporeal Injection / 대한비뇨기과학회지

PURPOSE: To investigate whether the result of RigiScan after intracorporeal injection could predict the result of duplex ultrasonography, and determine the necessity of duplex ultrasonography. MATERIALS AND METHODS: We performed both RigiScan and duplex ultrasonography after intracorporeal injection in 18 men with erectile dysfunction. All of the patients were evaluated by history taking, physical examination, laboratory test, hormonal tests, and neurologic examination before RigiScan and duplex ultrasonography. We measured maximal arterial diameter, peak systolic velocity, end-diastolic velocity using a 7 MHz. color Doppler unit and these results of duplex ultrasonography were compared with penile rigidity and tumescence measured by RigiScan. RESULTS: The positive and negative predictive value of RigiScan were 81.8% and 85.7%, respectively. The result of RigiScan was comparable with that of duplex ultrasonography and the accuracy of RigiScan was resonable. CONCLUSIONS: According to this results, duplex ultrasonography was needed if the response of RigiScan is abnormal after intracorporeal injection. However, duplex ultrasonography can be ommitted if the response of RigiScan is normal after intracorporeal injection.

Diagnostic Value of Nocturnal Penile Tumescence and Rigidity Monitoring according to the Causes of Erectile Dysfunction / 대한비뇨기과학회지

PURPOSE: We compared the outcome of nocturnal penile tumescence and rigidity(NPTR) monitoring by RigiScan(Dacomed Co., USA) with that of more invasive tests on patients with a complaint of erectile dysfunction, and analyzed the diagnostic value of NPTR monitoring according to the causes of erectile dysfunction. MATERIALS AND METHODS: From May 1995 to May 1998, a total of 112 patients with a complaint of erectile dysfunction underwent NPTR monitoring by RigiScan over 3 consecutive nights and had the etiologic diagnosis through multidisciplinary diagnostic tests including duplex penile doppler ultrasonography, dynamic infusion cavernosometry and cavernosography, dorsal nerve somatosensory evoked potential test and bulbocavernous reflex latency test. RESULTS: The rates of psychogenic and organic erectile dysfunction were 44.6% and 55.4%, respectively. The sensitivity of NPTR monitoring in differentiating organic from psychogenic erectile dysfunction was 67.7%. The types of NPTR monitoring were not consistent with the causes of erectile dysfunction. CONCLUSIONS: Although NPTR monitoring by RigiScan has been known as a useful test in differentiating organic from psychogenic erectile dysfunction, multidisciplinary diagnostic tests are mandatory for the etiologic diagnosis of erectile dysfunction.

A Clinical Comparative Study between Visual Stimulated Erection and Nocturnal Penile Erection by RigiScan / 대한비뇨기과학회지

With 80 cases of impotent patients (30 psychogenic, 50 organic : 39 vasculogenic, 2 neurogenic, 5 vasculogenic + neurogenic, 4 undetermined). we compared the penile rigidity and the change of penile circumference between the visual stimulated erection (VSE) and nocturnal penile erection (NPE) by RigiScan. The results were obtained as follows. 1. In psychogenic impotent patients, the maximal degree of penile rigidity of the basal and tip portions were similar in 21 NPE (70.0%) and 22 VSE (73.3%), and 6 VSE of above showed the rigidity below 10%. All 9 NPE (100%) and 5 VSE (62.5%), out of 9 NPE and 8 VSE dissociated cases, were more higher degree of rigidity in base than that of tip. 2. In organic impotent patients, the maximal degree of penile rigidity of the basal and tip portions were similar in 29 NPE (58.0%) and 39 VSE (78.0%), and 10 NPE (34.5%) and 22 VSE (56.4 %) of above showed the rigidity below 40%. Among the remainders 21 NPE and 11 VSE, the cases who represented dissociation, 18 NPE (85.7%) and 9 VSE (81.8%), the majority, were more higher degree of rigidity in base than that in tip. 3. There were 29 psychogenic (96.7%) and 30 organic (60.0%) impotent patients in NPE, and 7 psychogenic (23.3%) and 5 organic (10.0%) in VSE, who represented over 40% of rigidity more than 5 minutes both in tip and base of penis. 4. Among the all 80 cases, the changes in penile circumferences of the basal and tip portions were similar in 41 NPE (51.3%) and 39 VSE (48.8%), and in remainders, 26 NPE (66.7%) and 34 VSE (82.9%) showed more changes in base than tip. Therefore, we concluded that NPE is more significant than VSE for the diagnosis and evaluating the degree of organic impotence because the rigidity of NPE were more higher than VSE both in psychogenic and organic impotent patients. In the other hand, however, if VSE represents sufficient rigidity, enough rigidity will be expected in NPE, so VSE is useful screening test before NPE.

The Comparison of Nocturnal Erection Using Rigiscan with Erotic Erection Using Audiovisual Stimulating Penogram / 대한비뇨기과학회지

Penile erection is either sexual stimulating erection or nocturnal erection. The difference of precise mechanism between the two types is not clarified yet. In order to evaluate nocturnal erection, we used the Rigiscan which could simultaneously record nocturnal penile tumescence and rigidity. And sexual stimulating erection was evaluated by Audiovisual Stimulating Penogram which was introduced by Choi and Kim in 1987. The following results were obtained. The compatibility ratio of 16 normal sexual stimulating erection to nocturnal erection test was 56%, while that of 35 cases of abnormal sexual stimulating erection was 51% . The compatibility ratios of the group IIA and group IIC were 80% and 78%, respectively, revealing high percentage of concordance between the two types of erection. On the other hand, the compatibility ratio of group IIB was low(33%). From the results presented here, it can be concluded that the AVS-Penogram is useful for the screening test and to obtain more useful information, evaluation of the nocturnal erection using Rigiscan is necessary.

Clinical Value of Nocturnal Penile Erection by Rigiscan / 대한비뇨기과학회지

Continuous and simultaneous recording of nocturnal penile rigidity and tumescence is preferred than measuring tumescence alone to define the features of nocturnal penile erection and differentiate psychogenic from organic impotence. Rigiscan is suitable for this purpose. Authors studied to define the features of nocturnal penile erection by rigiscan in 24 normal Koreans and 18 patients with erectile dysfunction. The results were as follows : 1. In normal group, the number of normal erection was 4.2+/-0.9 times per night, duration was 21.1+/-7.4 minutes at tip and 26.3+/-9.8 minutes at base, tumescence change was 1.81+/-0.51 cm at tip and 2.23+/-0.72 cm at base, rigidity was 55.7+/-19.6 per cent at tip and 66.3+/-12.0 per cent at base. Maximal duration was 34.2+/-14.9 minutes at tip and 39.0+/-15.1 minutes at base, maximal tumescence change was 2.28+/-0.83 cm at tip and 2.64+/-0.78 cm at base, maximal rigidity was 65.4+/-11.8 per cent at tip and 75.8+/-12.5 per cent at base. The higher the age, the shorter the duration and number of events were(p<0.05). 2. In patient group, normal rigigram showed in 6 patients(3 of psychogenic, 3 of posterior urethral injury). Event and duration were shorter than normal group(p<0.05). The findings of flat trace or abnormal erection provide valuable information to screen the organic impotence.