EVALUATION OF ERECTILE DYSFUNCTION BY DYNAMIC INFUSION CAVERNOSOMETRYAND CAVERNOSOGRAPHY (DICC)

In a cooperative, private practice, multi-institutional impotence stud y, dynamic infusion cavernosometry and cavernosography (DICC) was perf ormed on 743 patients to make an accurate diagnosis and/or identify ca ndidates for penile revascularization. Maximum equilibrium intracorpor eal pressure achieved following papaverine and phentolamine injection (Phase I) averaged 29.42 +/- 0.76 mm Hg, approximately one third of no rmal erection pressure. Corporeal pressure fall from 150 mm Hg over th irty seconds (cavernosometry) averaged 82.38 +/- 1.33 mm Hg (Phase II) . The gradient between systolic and cavernosal artery pressure average d 42.84 +/- 1.12 mm Hg on the right and 43.33 +/- 1.13 mm Hg on the le ft (Phase III). Cavernosography at 90 mm Hg erection pressure was perf ormed in Phase IV. Of the 124 patients from one center who were review ed in greater detail, pure cavernosal artery insufficiency (CAI) was f ound in 25 (20.2%), corporeal veno-occlusive dysfunction (CVOD) in 26 (21.0%), and 73 patients (58.9%) demonstrated combined CAI and CVOD. D iabetics (n = 69) achieved lower equilibrium intracorporeal pressures than nondiabetics, had similar CVOD, and worse CAI. Smokers (n = 365) and patients with Peyronie's disease (n = 32) had erectile dysfunction similar to those without these conditions. Patients impotent after tr auma (n = 124) were younger, achieved higher intracorporeal pressures, and showed better corporeal veno-occlusive function than those withou t trauma. Complications of DICC were minimal and infrequent. After DIC C, 169 patients underwent internal pudendal arteriography, 105 had art erial bypass surgery with or without penile venous ligation procedures , and 45 had venous surgery alone. Dynamic infusion cavernosometry and cavernosography is a useful erectile function study to evaluate impot ence and can be performed easily in a private practice setting.