NEW DEVELOPMENTS IN THE DIAGNOSIS AND TREATMENT OF IMPOTENCE

New developments in the diagnosis and treatment of impotence or erecti le dysfunction are increasingly based on better understanding of the e rectile process. In 1978 it was thought that the failure of arterial i nflow was the main cause of male erectile dysfunction. Emphasis was pl aced on methods of corpus cavernosal revascularization. In recent year s, interest has shifted to abnormal cavernosal smooth muscle function. An understanding of the erectile process was greatly enhanced by intr acavernosal administration of vasoactive agents in 1982 and, more rece ntly, the use of prostaglandin E(1). These agents promote erection by causing smooth muscle to relax. The intracavernosal administration of vasoactive agents is now used in diagnosis and in therapy. Standard ap proaches to diagnosis and therapy still vary, but more rational steps are evolving. Considerable progress has been made in quantifying penil e blood flow. Increasingly effective therapies are available for an es timated 10 million American men suffering from erectile dysfunction. T herapies include the use of drugs, administering vasoactive agents int racavernosally, vacuum constrictor devices, and vascular interventions in highly selected cases of arterial or venous disease. These procedu res are being carefully reevaluated. Critical analysis of recent resul ts suggests that about 7% of men are amenable to vascular intervention s, with success rates approximating 70% when supplemental therapy is u sed.