Introduction: The objective of this study was to explore the role of intracavernous injection (ICI) and audiovisual sexual stimulation (AVSS) during real-time pharmacopenile Doppler ultrasonography (PDDU) in vasculogenic subtypes of erectile dysfunction. Materials and Methods: A total of 200 consecutive men with erectile dysfunction (ED) were enrolled. Each patient received 2 sessions of real-time PDDU. Session A was performed under ICI alone. Session B was performed under ICI plus AVSS. The interval between sessions was 7 days. Penile vascular parameters, including peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index, were monitored 5, 10 and 20 min after the start of the test. Patients were asked to describe the level of sexual arousal generated by choosing one of the pre-set answers. Results: In veno-occlusive ED, during session A, EDV at 10 min was significantly greater than at 5 and 20 min (p < 0.05). During session B, there was a significant difference regarding PSV in arteriogenic ED (p < 0.05). Mixed vasculogenic ED showed significant differences in PSV levels during session B, and EDV at 5 min was greater than at 10 and 20 min (p < 0.05). PDDU under ICI alone diagnosed 34 (17%), 35 (17.5%), 31 (15.5%) and 100 (50%) cases of arteriogenic, veno-occlusive, mixed vasculogenic and nonvasculogenic ED, respectively. The combination of ICI plus AVSS diagnosed 27 (13.5%), 44 (22%), 7 (3.5%) and 122 (60.7%) cases, respectively. Conclusions: Adding AVSS during PDDU improves the recording of physiologic erectile response and may help the physician to accurately evaluate the cause of ED.

Lue TF, Tanagho EA: Physiology of erection and pharmacological management of impotence. J Urol 1987;137:829-836.
Lue TF, Giuliano F, Montorsi F, et al: Summary of the recommendations on sexual dysfunctions in men. J Sex Med 2004;1:6-23.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB: Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151:54-61.
LeRoy TJ, Broderick GA: Doppler blood flow analysis of erectile function: who, when, and how. Urol Clin North Am 2011;38:147-154.
Altinkilic B, Hauck EW, Weidner W: Evaluation of penile perfusion by color-coded duplex sonography in the management of erectile dysfunction. World J Urol 2004;22:361-364.
Aversa A, Sarteschi LM: The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. J Sex Med 2007;4:1437-1447.
Jiang YQ, Yao DH, Fu Q: Pharmaco-penile duplex ultrasonography in the diagnosis of erectile dysfunction. Chin J Urol 1998;19:437-440.
Li H, Liang P, Zhang J, Ou S, Xiao J: Application of colour doppler ultrasonography after intracavernous injection in the diagnosis of erectile dysfunction. Chin J Mod Med 2007;17:2400-2402.
Hatzichristou DG, Saenz de Tejada I, Kupferman S, et al: In vivo assessment of trabecular smooth muscle tone, its application in pharmaco-cavernosometry and analysis of intracavernous pressure determinants. J Urol 1995;153:1126-1135.
Saenz de Tejada I, Moroukian P, Tessier J, Kim JJ, Goldstein I, Frohrib D: Trabecular smooth muscle modulates the capacitor function of the penis. Studies on a rabbit model. Am J Physiol 1991;260:H1590-H1595.
Katlowitz NM, Albano GJ, Morales P, Golimbu M: Potentiation of drug-induced erection with audiovisual sexual stimulation. Urology 1993;41:431-434.
Barrett D, Nehra A, King B: Hemodynamic interpretation following redosing during duplex Doppler ultrasonography; is there a change in diagnosis. J Urol 1997;157:179.
Montorsi F, Guazzoni G, Barbieri L, et al: The effect of intracorporeal injection plus genital and audiovisual sexual stimulation versus second injection on penile color Doppler sonography parameters. J Urol 1996;155:536-540.
Lue TF, Hricak H, Marich KW, Tanagho EA: Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology 1985;155:777-781.
de Meyer JM, Thibo P: The effect of re-dosing of vasodilators on the intracavernosal pressure and on the penile rigidity. Eur Urol 1998;33:293-296, discussion 296-297.
Montorsi F GG, Cestari A, Rigatti P: The role of audiovisual sexual stimulation in the evaluation of the impotent man; in Morales A (ed): Erectile Dysfunction: Issues in Current Pharmacotherapy. London, Informa Health Care, 1998, pp 71-79.
Montorsi F, Guazzoni G, Barbieri L, et al: Genital plus audiovisual sexual stimulation following intracavernous vasoactive injection versus re-dosing for erectile dysfunction - results of a prospective study. J Urol 1998;159:113-115.
Pescatori ES, Silingardi V, Galeazzi GM, Rigatelli M, Ranzi A, Artibani W: Audiovisual sexual stimulation by virtual glasses is effective in inducing complete cavernosal smooth muscle relaxation: a pharmacocavernosometric study. Int J Impot Res 2000;12:83-88, discussion 88-90.
Suetomi T, Endo F, Takeshima H, Akaza H: Evaluation of the effectiveness of sildenafil using questionnaire methods versus audio-visual sexual stimulation. Int J Urol 2005;12:369-373.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.