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.