Angiography of posttraumatic impotence.

Of 135 patients who underwent penile angiography at our institution, impotence was related to noniatrogenic trauma in 16. Impotence developed immediately following an isolated traumatic event in 14 patients, and months or years after repeated blunt perineal trauma in 2. Invasive vascular assessment facilitated diagnosis in all patients. Although the mechanism of trauma varied greatly, most patients had vasculogenic (arteriogenic or venogenic) impotence. Complete vascular assessment required selective magnification pharmacoarteriography in multiple projections, pharmacocavernosography, and pharmacocavernosometry. Therapeutic choices were based largely on the angiographic findings, and included venous ligation, arterial bypass or angioplasty, self-injection of papaverine, or insertion of a prosthesis.

Nocturnal penile tumescence.

NPT monitoring remains the best single non-invasive examination to differentiate organic from psychogenic impotence. The need to measure rigidity concurrently with tumescence during NPT is well known, thus making monitoring with the RigiScan, which measures these parameters, the procedure of choice when evaluating NPT.

Posttraumatic impotence: angiographic evaluation.

The onset of impotence was related to penile trauma in ten of 90 patients who underwent angiography. Angiographic results facilitated diagnosis in all patients. Trauma was secondary to a variety of injuries including fractures, soft-tissue perineal injuries without fractures, and repeated perineal pounding during long, jarring drives. The final diagnosis was arteriogenic impotence (n = 2), arteriovenogenic impotence (n = 2), venogenic impotence (n = 3), venoneurogenic impotence (n = 1), neurogenic impotence (n = 1), and psychogenic impotence (n = 1). Proper angiographic evaluation required refined angiographic techniques such as selective magnification pharmacoarteriography, pharmacocavernosography, and pharmacocavernosometry. A variety of therapeutic options were either recommended or applied, depending on the angiographic findings. These included venous ligation, arterial bypass, injections of papaverine hydrochloride, and insertion of penile prostheses.

Gallium-67 imaging to localize urinary-tract infections.

To differeniate upper from lower-tract urinary infections, 73 patients were imaged with 67Ga citrate. Renal uptake of the radioisotope occurred in pyelonephritis (documented in 47 patients by ureteral cathieterization, bladder washout, or histology) with an accuracy of 86%. There were 15% false-positives and 13% false-negatives. 67Ga may prove to be a clinically valuable test in the diagnosis of pyelonephritis. Results are promptly available 24 hours after injection, and it is non-invasive test that can safely be repeated to follow recurrent infections.

Gallium-67 scans in the diagnosis of pyelonephritis.

Gallium-67 ((67)Ga) citrate was administered intravenously (50 microcuries per kg of body weight) to patients in whom acute and chronic urinary tract infections were suspected. Scanning was done, using both the Anger-type scintillation camera and the rectilinear scanner, 24 to 78 hours after injection of the isotope. The preliminary results imply that (67)Ga renal uptake is present in patients with pyelonephritis whether overt or silent, as well as in patients with uretero-sigmoidostomies. However, (67)Ga renal uptake is not present in patients with radiographic evidence of chronic pyelonephritis without active infection and in patients without renal disease.