Bookstein J J, Valji K, Parsons L, Kessler W
J Urol. 1987 Apr;137(4):772-6. doi: 10.1016/s0022-5347(17)44208-x.
Within the past few years, veno-occlusion of the corpora cavernosa has become generally recognized as an essential prerequisite for adequate penile erection. Veno-occlusive incompetence is suspected to be a frequent cause of impotence. Our recent experience with cavernosography in two normal volunteers and 36 impotent patients indicates that angiography is reliable in evaluating the competence of the veno-occlusive mechanism only if both pharmacocavernosography (PCG) and pharmacocavernosometry (PCM) are applied. Twenty minutes after intracavernosal (IC) injection of a mixture of 60 mg. papaverine and one mg. phentolamine (regitine), 100 ml. of diluted radiographic contrast medium are infused at the rate of one or two ml./sec. while pressure is recorded, and radiographic films are exposed at the rate of one every eight to 15 seconds. PCM and PCG of the corpora cavernosa indicated the overall degree of competence of the cavernosal veno-occlusive mechanisms, and the sites of veno-occlusive incompetence; non-pharmacologic studies were unreliable in these regards. During non-pharmacologic infusion in normals, pressures rose to 40 to 45 mm. Hg, and free efflux could be visualized from multiple venous systems. After pharmacologic injection in normals, all venous channels closed, and pressures rapidly rose toward or above 200 mm. Hg, at which time the infusion was stopped. Veno-occlusive incompetence was defined angiographically when more than minimal efflux occurred during pharmacocavernosography from any venous system. The incompetence could involve the deep penile system, the deep dorsal system, or the spongiosal system, alone or in combination. Severe veno-occlusive incompetence was considered diagnostic of venogenic impotence, and was defined manometrically when IC pressures failed to exceed 100 mm. Hg during infusion of 100 ml. of fluid at 2 mm./second after IC papaverine and phentolamine injection. We believe these angiographic methods will improve the criteria against which other diagnostic and therapeutic methods can be assessed.
在过去几年中，海绵体静脉闭塞已被普遍认为是阴茎充分勃起的必要前提。静脉闭塞功能不全被怀疑是阳痿的常见原因。我们最近对两名正常志愿者和36名阳痿患者进行海绵体造影的经验表明，只有同时应用药物海绵体造影（PCG）和药物海绵体测压（PCM），血管造影在评估静脉闭塞机制的功能方面才是可靠的。在海绵体内注射60毫克罂粟碱和1毫克酚妥拉明（立其丁）的混合物20分钟后，以每秒1或2毫升的速度注入100毫升稀释的造影剂，同时记录压力，并以每8至15秒一张的速度拍摄X光片。海绵体的PCM和PCG表明海绵体静脉闭塞机制的整体功能程度以及静脉闭塞功能不全的部位；在这些方面，非药物研究是不可靠的。在正常情况下进行非药物灌注时，压力升至40至45毫米汞柱，可以看到多个静脉系统有自由流出。在正常情况下进行药物注射后，所有静脉通道关闭，压力迅速升至或超过200毫米汞柱，此时停止灌注。当在药物海绵体造影期间任何静脉系统出现超过最小流出量时，血管造影上定义为静脉闭塞功能不全。功能不全可能单独或联合累及阴茎深部系统、阴茎背深系统或海绵体系统。严重的静脉闭塞功能不全被认为是静脉性阳痿的诊断标准，当在海绵体内注射罂粟碱和酚妥拉明后以每秒2毫米的速度注入100毫升液体时，海绵体内压力未能超过100毫米汞柱，则通过测压来定义。我们相信这些血管造影方法将改进用于评估其他诊断和治疗方法的标准。
