THE EFFECT OF INTRACORPOREAL INJECTION PLUS GENITAL AND AUDIOVISUAL SEXUAL STIMULATION VERSUS 2ND INJECTION ON PENILE COLOR DOPPLER SONOGRAPHY PARAMETERS

Purpose: We assessed whether genital and audiovisual sexual stimulatio n following 1 or 2 intracorporeal injections caused the greatest chang es in penile hemodynamics as recorded by color Doppler sonography. Mat erials and Methods: A total of 50 impotent patients underwent multipha sic color Doppler sonography of the cavernous arteries before and afte r intracorporeal injection (phase 1), subsequent genital and audiovisu al sexual stimulation (phase 2), a second injection (phase 3) and repe at genital and audiovisual sexual stimulation (phase 4). Peak systolic velocity, end diastolic velocity, resistance index and erectile respo nse were studied. Results: Penile erection after injection 1 was upgra ded in 41 patients (82%) by genital and audiovisual sexual stimulation . Further upgrading due to injection 2 with stimulation was noted in 1 1 patients (22%). Among the patients who completed the 4 phases of the test the maximal peak systolic velocity was noted after 1 and 2 injec tions in 20 (59%) and 14 (41%), respectively. The resistive index was always increased by genital and audiovisual sexual stimulation compare d 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 genit al and audiovisual sexual stimulation, impotence was diagnosed as nonv asculogenic in 14 patients (28%), arteriogenic in 9 (18%), venogenic i n 17 (34%) or mixed arterio-venogenic in 10 (20%). After injection 2 w ith stimulation these results were noted in 18 (36%), 9 (18%), 13 (26% ) and 10 (20%) patients, respectively. Thus, there were 4 false-positi ve cases (8%) of venogenic impotence. Conclusions: To study cavernous artery inflow and veno-occlusive function, color Doppler sonography sh ould be performed after injection plus genital and audiovisual sexual stimulation. When the erectile response does not equal the maximal phy siological erection reported by the patient, a second injection with s timulation should be given.