Vasculogenic impotence: role of the pelvic steal test.

A new dynamic pelvic flow test is described that measures differential right and left corporeal artery blood pressure changes with exercise. Previous penile blood flow measurements have been made at rest. It is well known that exercise may unmask vascular pathological conditions not apparent at rest. Furthermore, cases have been reported that document potency at rest and impotence following exercise. As a result exercise was used to stress the pelvic vasculature in 97 patients chosen from vascular and urology clinics. A decrease of 0.15 or more in penile-brachial index with exercise was found to be statistically abnormal. A total of 23 patients (27 per cent) fulfilled the criteria for positive pelvic steal testing. In this group there were high incidences of smoking (52 per cent), hypertension (52 per cent) and diabetes (30 per cent). Although 70 per cent of these patients had at least occasional morning erections 78 per cent complained of loss of erection with exercise. The pelvic steal test detected vascular pathological conditions in 17 patients (20 per cent) previously missed by resting penile-brachial index measurements. Nocturnal penile tumescence studies in these patients demonstrated poor quality erections and correlated with the intermediate penile-brachial index values. Angiographic data performed in 5 of 23 patients corroborated the pathophysiology of a pelvic steal condition in each case. The pelvic steal test is simple to perform and markedly improves the sensitivity and yield of penile blood pressure measurements. The test appears to have better results in patients with suspected vasculogenic impotence and intermediate resting penile-brachial index values.