Montorsi F, Guazzoni G, Barbieri L, Galli L, Rigatti P, Pizzini G, Miani A
Institute of Human Anatomy, University of Milan School of Medicine, H. San Raffaele, Italy.
J Urol. 1996 Feb;155(2):536-40.
We assessed whether genital and audiovisual sexual stimulation following 1 or 2 intracorporeal injections caused the greatest changes in penile hemodynamics as recorded by color Doppler sonography.
A total of 50 impotent patients underwent multiphasic color Doppler sonography of the cavernous arteries before and after intracorporeal injection (phase 1), subsequent genital and audiovisual sexual stimulation (phase 2), a second injection (phase 3) and repeat genital and audiovisual sexual stimulation (phase 4). Peak systolic velocity, end diastolic velocity, resistance index and erectile response were studied.
Penile erection after injection 1 was upgraded in 41 patients (82%) by genital and audiovisual sexual stimulation. Further upgrading due to injection 2 with stimulation was noted in 11 patients (22%). Among the patients who completed the 4 phases of the test the maximal peak systolic velocity was noted after 1 and 2 injections in 20 (59%) and 14 (41%), respectively. The resistive index was always increased by genital and audiovisual sexual stimulation compared to post-injection values. The maximal resistive index occurred after initial and repeat genital and audiovisual sexual stimulation in 15 (48%) and 16 (52%) patients, respectively. After injection 1 with genital and audiovisual sexual stimulation, impotence was diagnosed as nonvasculogenic in 14 patients (28%), arteriogenic in 9 (18%), venogenic in 17 (34%) or mixed arteriovenogenic in 10 (20%). After injection 2 with stimulation these results were noted in 18 (36%), 9 (18%), 13 (26%) and 10 (20%) patients, respectively. Thus, there were 4 false-positive cases (8%) of venogenic impotence.
To study cavernous artery inflow and veno-occlusive function, color Doppler sonography should be performed after injection plus genital and audiovisual sexual stimulation. When the erectile response does not equal the maximal physiological erection reported by the patient, a second injection with stimulation should be given.
我们评估了在进行1次或2次海绵体内注射后，生殖器及视听性刺激是否会如彩色多普勒超声记录的那样，引起阴茎血流动力学的最大变化。
共有50例阳痿患者在海绵体内注射前及注射后（第1阶段）、随后的生殖器及视听性刺激（第2阶段）、第2次注射（第3阶段）以及重复的生殖器及视听性刺激（第4阶段）接受了海绵体动脉多相彩色多普勒超声检查。研究了收缩期峰值流速、舒张末期流速、阻力指数及勃起反应。
在41例患者（82%）中，第1次注射后通过生殖器及视听性刺激阴茎勃起得到改善。在11例患者（22%）中，观察到第2次注射并伴有刺激后勃起进一步改善。在完成4个测试阶段的患者中，分别有20例（59%）和14例（41%）在第1次和第2次注射后出现最大收缩期峰值流速。与注射后的值相比，生殖器及视听性刺激总是会使阻力指数增加。分别有15例（48%）和16例（52%）患者在初次及重复的生殖器及视听性刺激后出现最大阻力指数。在第1次注射并伴有生殖器及视听性刺激后，14例患者（28%）被诊断为非血管性阳痿，9例（18%）为动脉性阳痿，17例（34%）为静脉性阳痿，10例（20%）为混合性动静脉性阳痿。在第2次注射并伴有刺激后，这些结果分别出现在18例（36%）、9例（18%）、13例（26%）和10例（20%）患者中。因此，有4例假阳性静脉性阳痿病例（8%）。
为研究海绵体动脉血流及静脉闭塞功能，应在注射加生殖器及视听性刺激后进行彩色多普勒超声检查。当勃起反应达不到患者报告的最大生理性勃起时，应进行第2次注射并伴有刺激。
