Abstract
The purpose of this work was to assess whether a single intracavernous injection (ICI) of a low dose of the combination of papaverine–phentolamine is replaceable by a high dose of the oral erectogenic agent sildenafil as mode of stimulation during pharmaco-penile duplex ultrasonography (PPDU). Eleven patients with complaints of erectile dysfunction were included in a crossover study. With an interval of two weeks the patients were exposed to ICI with papaverine/phentolamine (3.75 mg/0.125 mg) and oral administration with sildenafil (100 mg) preceding PPDU. Five patients started with ICI. Six patients started with sildenafil. In the sildenafil stimulation mode, visual erotic stimulation (VES) was used to initiate erection. VES was applied by personal LCD monitor. Cut-off values to define sufficient arterial response were: peak flow velocity (PSV) >25 cm/s and acceleration time (AT) <72 ms. Cut-off value to define sufficient veno-occlusion was a resistance index ≥1.00. Statistical analysis of PPDU parameters shows no significant difference between the two modes of stimulation for arterial response (PSV, AT), whereas the resistance index, as a parameter of veno-occlusive response was significantly higher in the sildenafil mode. This finding is confirmed in the clinical translation of the results: two patients with an insufficient arterial response to ICI had a sufficient arterial response to sildenafil and only one patient showed an insufficient arterial response following sildenafil, whereas the response following ICI was sufficient. Analysis of veno-occlusive responses shows remarkable differences between both modes of stimulation. Whereas following the administration of sildenafil all veno-occlusive responses were classified as sufficient, seven patients showed an insufficient veno-occlusive response following ICI. As mode of stimulation in PPDU, high dose sildenafil yields significantly less false positive diagnoses of ‘veno-occlusive dysfunction’ than intracavernous injection of the combination papaverine/phentolamine. No difference was found in the quality of the arterial response. Based on this study we conclude that sildenafil may replace ICI as mode of stimulation during PPDU.
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References
Lue TF, Mueller SC, Jow YR, Hwang TI . Functional evaluation of penile arteries with duplex ultrasound in vasodilator-induced erection. Urol Clin North Am 1989 16, 799–807
Lue TF, Hricak H, Marich KW, Tanagho EA . Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology 1985 155, 777–781
Levine SB et al. Side effects of self-administration of intracavernous papaverine and phentolamine for the treatment of impotence. J Urol 1989 141, 54–57
Heaton JPW, Adams MA, Morales A . A therapeutic taxonomy of treatments for erectile dysfunction. An evolutionary imperative. Int J Impot Res 1997 9, 115–121
Meuleman EJ et al. Penile pharmacological duplex ultrasonography: a dose–effect study comparing papaverine, papaverine/phentolamine and prostaglandin E1. J Urol 1992 148, 63–66
Arslan D et al. A noninvasive method in the evaluation of erectile dysfunction: sildenafil+penile doppler ultrasonography. J Urol 2000 163, A1072, 241
Lehmann K et al. Variable response to intracavernous prostaglandin E1 testing erectile dysfunction. Urology 1999 54, 539–543
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We thank Michiel Sedelaar who assisted in study design preparation and Herman van Lange for valuable comments.
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Speel, T., Bleumer, I., Diemont, W. et al. The value of sildenafil as mode of stimulation in pharmaco-penile duplex ultrasonography. Int J Impot Res 13, 189–191 (2001). https://doi.org/10.1038/sj.ijir.3900704
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DOI: https://doi.org/10.1038/sj.ijir.3900704