Lehmann K, Kacl G, Hagspiel K, Hauri D
Urologische Klinik, Kantonsspital Basel.
Urologe A. 1996 Nov;35(6):456-61; discussion 461-2. doi: 10.1007/s001200050052.
Erectile dysfunction has taken on increasing importance in urologic practice. Still open is the question of which tests are mandatory for adequate clinical assessment of erectile dysfunction. One accepted standard modality is the intracavernous pharmacotest with vasoactive agents. In contrast, color duplex sonography is not considered mandatory although it reveals detailed information about penile vessels and functional implications. The question remains whether the information gained by color duplex sonography is relevant for therapy, making it an indispensable standard procedure. Patients with erectile dysfunction were evaluated, without preselection, by extensive history, clinical evaluation, laboratory tests, tumescence and rigidity measurements, intracavernous administration of vasoactive drugs and color duplex sonography. Seventy-nine patients were available for final analysis. Color duplex sonography revealed 39 normal tests, 16 arterial impairments. 19 venous leakages and 5 arteriovenous fistulae. Intracavernous vasoactive agents (pharmacotest) revealed 44 reactions sufficient for intercourse and 35 insufficient responses. In 89% of patients, the diagnoses on color duplex sonography and intracavernous pharmaco-testing were similar. The accuracy of the two methods in diagnosing erectile dysfunction was not statistically different (McNemar's test). In contrast to intracavernous pharmaco-testing, color duplex sonography permitted further etiologic subdivision into arterial disease, venous leakage, arteriovenous fistula and normal result. This was made possible by measuring significantly (P < 0.01) different arterial peak flow velocities, end-diastolic velocities and calculated resistance index. These data did not imply direct clinical consequences. Color duplex sonography and intracavernous pharmacotesting reveal comparable results concerning the diagnosis of an erectile dysfunction. In contrast to pharmacotesting, color duplex sonography reveals details of the nature of the erectile dysfunction. Because this information has no profound implications for the choice of therapeutic procedure, color duplex sonography can not be recommended as a standard procedure in the evaluation of erectile dysfunction.
勃起功能障碍在泌尿外科临床实践中愈发重要。对于勃起功能障碍进行充分临床评估时哪些检查是必需的，这一问题仍未解决。一种公认的标准方法是使用血管活性药物进行海绵体内药物试验。相比之下，彩色双功能超声检查虽能提供有关阴茎血管和功能影响的详细信息，但并不被视为必需检查。彩色双功能超声检查所获信息对治疗是否有意义，从而使其成为不可或缺的标准检查方法，这一问题依然存在。对勃起功能障碍患者进行了全面评估，未进行预先筛选，评估内容包括详尽病史、临床检查、实验室检查、阴茎肿胀和硬度测量、海绵体内注射血管活性药物以及彩色双功能超声检查。79例患者可供最终分析。彩色双功能超声检查显示39例检查结果正常，16例动脉功能受损，19例静脉漏，5例动静脉瘘。海绵体内注射血管活性药物（药物试验）显示44例反应足以进行性交，35例反应不足。89%的患者中，彩色双功能超声检查和海绵体内药物试验的诊断结果相似。两种方法在诊断勃起功能障碍方面的准确性无统计学差异（McNemar检验）。与海绵体内药物试验不同，彩色双功能超声检查可进一步将病因细分为动脉疾病、静脉漏、动静脉瘘和正常结果。通过测量显著不同（P<0.01）的动脉峰值流速、舒张末期流速和计算阻力指数得以实现。这些数据并未表明有直接临床意义。彩色双功能超声检查和海绵体内药物试验在勃起功能障碍诊断方面显示出可比结果。与药物试验不同，彩色双功能超声检查揭示了勃起功能障碍的性质细节。由于该信息对治疗方法的选择没有深远影响，彩色双功能超声检查不能被推荐为评估勃起功能障碍的标准检查方法。
