Speel T G, Bleumer I, Diemont W L, van der Maas M C, Wijkstra H, Meuleman E J
Department of Urology, University Medical Centre, Nijmegen, The Netherlands.
Int J Impot Res. 2001 Aug;13(4):189-91. doi: 10.1038/sj.ijir.3900704.
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 > or =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.
本研究旨在评估在药物性阴茎双功能超声检查（PPDU）期间，低剂量罂粟碱 - 酚妥拉明联合制剂的单次海绵体内注射（ICI）是否可被高剂量口服勃起剂西地那非替代作为刺激方式。11例主诉勃起功能障碍的患者纳入一项交叉研究。在PPDU前，患者间隔两周分别接受罂粟碱/酚妥拉明（3.75mg/0.125mg）的ICI和西地那非（100mg）口服给药。5例患者从ICI开始，6例患者从西地那非开始。在西地那非刺激模式下，使用视觉性刺激（VES）诱发勃起。通过个人液晶显示器应用VES。定义充分动脉反应的临界值为：峰值流速（PSV）>25cm/s且加速时间（AT）<72ms。定义充分静脉闭塞的临界值为阻力指数≥1.00。PPDU参数的统计分析显示，两种刺激模式在动脉反应（PSV、AT）方面无显著差异，而作为静脉闭塞反应参数的阻力指数在西地那非模式下显著更高。这一发现在结果的临床转化中得到证实：2例对ICI动脉反应不足的患者对西地那非有充分的动脉反应，而只有1例患者在服用西地那非后动脉反应不足，而ICI后的反应是充分的。静脉闭塞反应分析显示两种刺激模式之间存在显著差异。服用西地那非后所有静脉闭塞反应均被分类为充分，而7例患者在ICI后显示静脉闭塞反应不足。作为PPDU中的刺激方式，高剂量西地那非产生的“静脉闭塞功能障碍”假阳性诊断明显少于海绵体内注射罂粟碱/酚妥拉明联合制剂。动脉反应质量方面未发现差异。基于本研究，我们得出结论，在PPDU期间，西地那非可替代ICI作为刺激方式。
