Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Department of Reproductive Medicine, The First People's Hospital of Yunnan Province, Kunming, Yunnan 650032, China.
Chin Med J (Engl). 2018 Jun 20;131(12):1465-1471. doi: 10.4103/0366-6999.233945.
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.
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.
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.
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.
目前用于评估阴茎勃起和硬度的评估标准存在很大争议。在这项研究中，我们试图通过使用视听性刺激和 RigiScan™（PDE5 抑制剂）检测建立中国男性正常阴茎勃起和硬度的评估标准。
共 1169 名年龄在 18-67 岁之间的勃起功能障碍（ED）患者接受了视听性刺激和 RigiScan™（PDE5 抑制剂）检测。通过病史、内分泌、血管和神经诊断、国际勃起功能指数 5 问卷和勃起硬度评分，对最终病因诊断准确的 1078 名患者进行了研究。使用逻辑回归模型和受试者工作特征曲线分析来确定 RigiScan™数据的截断值。然后，在选定的变量中使用多变量逻辑分析。
正常结果定义为勃起后根部硬度持续超过 60%，至少 8.75 分钟；龟头平均事件硬度至少为 43.5%，根部至少为 50.5%；龟头平均最大硬度至少为 62.5%，根部至少为 67.5%；龟头增加（最大-最小勃起）至少 1.75 厘米，根部至少 1.95 厘米；总勃起时间至少 29.75 分钟；总勃起次数至少 1 次。最重要的是，根部硬度持续超过 60%，至少 8.75 分钟；龟头平均事件硬度至少 43.5%，根部至少 50.5%，将作为阴茎勃起和硬度的新的中国正常评估标准。通过多变量逻辑回归分析，总勃起次数、勃起持续时间超过 60%的时间、龟头平均事件硬度、龟头增加、根部平均事件硬度和根部增加这 6 个 RigiScan™参数对 ED 的风险模型有贡献。在逻辑回归方程中，预测值 P<0.303 被认为是心因性 ED。AVSS-RigiScan 检测联合 PDE5 抑制剂在鉴别心因性和器质性 ED 方面的敏感性和特异性分别为 87.7%和 93.4%。
本研究表明，口服 PDE5 抑制剂的视听性刺激和 RigiScan 检测可以客观评估阴茎勃起和硬度，似乎是鉴别心因性和器质性 ED 的更好方法。但是，由于样本量有限，仍可能存在偏倚。
