Venous incompetence: critical study of the organic basis of high maintenance flow rates during artificial erection test.

We tested whether the necessity for high flow rates of saline to maintain an artificial erection actually corresponds to an organic abnormality able to induce impotence as claimed recently. A total of 56 patients with presumed vascular impotence and 13 with typical psychogenic impotence underwent dynamic cavernosography followed by the artificial erection test. The former 56 patients also underwent bilateral selective internal iliac arteriography. A severely elevated maintenance flow rate (more than 120 ml. per minute) was found in 19 of the 56 patients with vascular and none of the 13 with psychogenic impotence, while a moderately elevated maintenance flow rate (80 to 120 ml. per minute) was found in 11 and 3, respectively. In most cases a severely elevated maintenance flow rate was associated with arterial (16 patients) or neurological abnormalities able to disturb erection. However, a severely elevated maintenance flow rate seemed to correspond to an organic abnormality able to induce impotence or to worsen erectile failure induced by other organic factors. Indeed, we found no severely elevated maintenance flow rates among our 13 patients with psychogenic impotence and the nocturnal penile tumescence test was normal in only 1 of 12 tested patients, although 7 had no other organic impairment sufficient to induce impotence (only moderate arterial stenoses in 4). In addition, sexual treatment succeeded in only 1 of the 13 patients, while our success rate is 43 per cent among patients with arterial impotence exclusively and this treatment succeeded in 6 of 10 patients with a moderately elevated maintenance flow rate. On the contrary, a moderately elevated maintenance flow rate does not seem to correspond to a genuine organic abnormality able to induce impotence. Indeed, we found it in 3 of 13 patients with psychogenic impotence, and every patient with a moderately elevated maintenance flow rate and normal arteries had a normal nocturnal penile tumescence test or was cured by sexual therapy. In conclusion, a maintenance flow rate exceeding 120 ml. per minute seems to reveal a genuine venous incompetence but in most cases this abnormality is only the cofactor of an arterial obstruction.