Erectile dysfunction diagnosis

Erectile dysfunction must be distinguished from disorders of libido, ejaculatory disorders, or infertility, which are caused by different pathophysiologic mechanisms and are treated with alternative agents (Table 81-1). A patient may suffer from one or more disorders of sexual dysfunction. For example, an elderly man with primary hypogonadism may suffer from decreased libido and erectile dysfunction. Diagnosis of the type of sexual disorder that a patient has is a key to initiating the most appropriate treatment. 

Intracavernosal alprostadil may be a useful adjunct to other diagnostic tests in the diagnosis of erectile dysfunction (Cave/yecf only). 

Adjunct to the diagnosis of erectile dysfunction (Caverject only) - Patients are monitored for the occurrence of an erection after an intracavernosal injection of alprostadil. Use a single dose of alprostadil that induces a rigid erection. 

Saenz de Tejada 1, Moreland RB. Physiology of erection, pathophysiology of impotence and implications of PGEl in the control of collagen synthesis in the corpus cavernosum. In Goldstein I, Lue TF, eds. The Role of Alprostadil in the Diagnosis and Treatment of Erectile Dysfunction. Princeton, Excerpta Medica, 1993 3-16. 

Prior to instrumental or invasive procedures, patient-reported assessment should be performed. Patient self report, administered questionnaires, event logs or simple patient diaries are commonly used for the diagnosis of erectile dysfunction (Rosen et al. 2006). 

Veno-occlusive erectile dysfunction is more common in clinical practice and is usually observed in younger patients without arterial disease. As confirmed by cavernosography and cavernosomanom-etry (Kropman et al. 1992), the diagnosis is made on the basis of a high and persistent peak systolic velocity, which is superior to the cut-off values of 35 cm/s, and end diastolic velocity (Fig. 6.12) with a sensitivity of 90-94%. 

Peyronie s disease is characterized by formation of fibrous tissue plaques within the tunica albuginea causing penile pain, deformity, and shortening. As illustrated in Chapter 7, the diagnosis is based on medical history, autophotography, and a clinical examination with plaque palpation. Ultrasound and other imaging modalities are confirming and allow accurate evaluation of disease extent and assessment of associated erectile dysfunction. 

Gilbert DA, Horton CE, Terzis JK, et al. (1987) New concepts in phallic reconstruction. Ann Plast Surg 18 128-136 Goldstein I, Krane R (1992) Diagnosis and therapy of erectile dysfunction. In Walsh P, Gittes R, Perlmutter A, Stamey T (eds) Campbell s Urology. WB Saunders, Philadelphia, pp 3033-3067... 

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