Martins F E, Reis J P
Department of Urology, Hospital Pulido Valente, Lisbon, Portugal.
J Urol. 1997 Jan;157(1):134-9.
We determined the role and validity of visual erotic stimulation using RigiScan monitoring as a more physiological and cost-effective diagnostic modality for primary noninvasive screening of psychogenic versus organic impotence. We also clarified the correlation between erotic and pharmacological erections, and their diagnostic usefulness in the clinical routine.
A total of 76 impotent patients and 20 potent controls were entered into the study. A detailed medical and sexual history was obtained, and psychological evaluation and minimally invasive diagnostic studies were done, including a 15-minute visual erotic stimulation test, intracavernous pharmacological stimulation with 10 micrograms. prostaglandin E1 and penile duplex ultrasound. Responses to each test were interpreted blindly and independently of each other, and of the results of the psychological evaluation. Visual erotic stimulation results were then correlated with the results of intracavernous pharmacological stimulation and penile duplex ultrasound, and validity assessments were also obtained.
Results of the visual erotic stimulation test confirmed the clinical diagnosis in 10 of the 14 patients (71%) with psychogenic impotence (71% sensitivity and 96% specificity). There was a 97% correlation with the clinical diagnosis of predominantly organic dysfunction (97% sensitivity and 71% specificity). However, characterization of the etiological inferences based on visual erotic stimulation findings was poor.
A positive response to visual erotic stimulation is strongly indicative of a predominantly psychogenic cause of erectile dysfunction. In combination with patient sexual history and pharmacological erection testing, visual erotic stimulation can be performed as an initial, minimally invasive test for cost-effective screening of psychogenic impotence.
我们确定了使用RigiScan监测进行视觉性刺激的作用和有效性，将其作为一种更具生理性且成本效益更高的诊断方式，用于对心因性与器质性阳痿进行原发性无创筛查。我们还阐明了性刺激勃起与药物性勃起之间的相关性，以及它们在临床常规中的诊断效用。
共有76例阳痿患者和20例有正常勃起功能的对照者纳入本研究。获取详细的病史和性史，并进行心理评估和微创诊断研究，包括15分钟的视觉性刺激试验、用10微克前列腺素E1进行海绵体内药物刺激以及阴茎双功能超声检查。对每项检查的反应由专人独立、盲法解读，且与心理评估结果无关。然后将视觉性刺激结果与海绵体内药物刺激及阴茎双功能超声检查结果进行相关性分析，并进行有效性评估。
视觉性刺激试验结果在14例心因性阳痿患者中的10例（71%）中证实了临床诊断（敏感性71%，特异性96%）。与以器质性功能障碍为主的临床诊断有97%的相关性（敏感性97%，特异性71%）。然而，基于视觉性刺激结果进行病因推断的特征并不理想。
对视觉性刺激的阳性反应强烈提示勃起功能障碍主要由心因性因素引起。结合患者性史和药物性勃起测试，视觉性刺激可作为一种初始的、微创的检查，用于经济高效地筛查心因性阳痿。
