[Evaluation of erection disorder]. / Bilan d'un trouble de l'érection.

A multidisciplinary approach to screening for a disorder of erection has been applied over the last 7 years and involves dynamic and particularly physiologic explorations. When an organic etiology cannot be excluded during the first consultation and after a clinical examination, the basic paraclinical investigation used is the measurement of nocturnal erections (NPT). Although NPT remains the key-examination, it may be necessary to request vascular exploration, mainly study of the Döppler effect, a neurologic examination to include peripheral and autonomic nervous systems and endocrine tests.

[Hydraulic penile prostheses in the surgery of impotence. Our experience in 20 cases with a 2-year follow-up]. / Prothèses péniennes hydrauliques dans la chirurgie de l'impuissance. Notre expérience sur vingt cas avec deux ans de recul.

The authors report their experience of the implantation of inflatable penile prostheses in the surgical management of impotence. They have implanted twenty prostheses with a followup of two years to three months. The overall results are very satisfactory in terms of the quality of the sexual life of the couple (85%). On the other hand, the postoperative morbidity rate is high, with 40% of complications including 20% requiring reoperation.

[Personal experience of sleep plethysmography in the differential diagnosis of erection disturbances (author's transl)]. / Notre expérience de la pléthysmographie de sommeil dans le diagnostic différentiel des troubles de l'érection.

The authors feel that penile erection during sleep represents the first stage in the investigation of erection problems. The aim is to distinguish between psychogenic impotence the organic impotence. The authors simultaneously perform plethysmography and an electroencephalogram during sleep. Sixty five patients have been investigated in this way. In 44 cases the occurrence of nocturnal penile erection led to the conclusion of a psychogenic origin whilst in 21 cases the results of plethysmography were pathological. Amongst these 21 patients, undergoing vascular investigations, 12 underwent revascularisation of the corpora cavernosa and 12 the insertion of an erection prosthesis. It may be noted that revascularization using the epigastric artery gave widely disparate results: 2 good results amongst 9 patients, with one failure and six inadequate erections. The authors emphasise the fact that there is little alteration in sleep in cases of organic impotence and that phases of paradoxal sleep recur periodically without any great variation in the plethysmographic curve. By contrast, in functional impotence, sleep is invariably disturbed. A whole series of factors are involved in the assessment of the results: total duration of sleep, duration of paradoxal sleep, ratio of paradoxal sleep to total sleep, total erection time, total time in maximum erection and the ratio of erection time to paradoxal sleep. Analysis of sleep is thus a fundamental factor in the proper interpretation of the results of plethysmography in an importance sufferer.