DOES THE POSITIVE INTRACAVERNOUS PAPAVERINE TEST ALWAYS INDICATE A NORMAL PENILE VASCULAR SYSTEM

Objective: A positive intracavernous papaverine test has been presumed to determine normal erectile hemodynamics. Recently, positive erectil e responses to intracorporeal injection tests were reported in patient s with penile arterial insufficiency. Methods: This hypothesis was ass essed by obtaining hemodynamic data using color Doppler ultrasonograph y in 417 patients with erectile dysfunction aged between 20 and 73 yea rs (mean 43.06 +/- 13.66). A normal penile vascular system was found i n 95 patients (22.79%), veno-occlusive dysfunction in 76 (18.22%), art eriogenic erectile dysfunction (ED) in 113 (27.10%) and mixed-type ED in 133 (31.89%). Results: A positive erection response was achieved in 176 patients with combined intracavernosal injection of 60 mg papaver ine and self-manual genital stimulation (CIS) test, while a negative r esponse was observed in the remaining 241 (57.79%). Color Doppler ultr asonography combined with pharmacological erection has proved a normal penile vascular system in 94 (53.41%) and penile arterial insufficien cy in 82 (46.59%) patients of those who gave a positive response to th e CIS test. Also, a positive CIS test response was observed in all pat ients with unilateral arterial insufficiency (n = 31) and in 51 patien ts (62.19%) out of 82 with bilateral arterial insufficiency. Conclusio n: A positive intracavernous papaverine test indicates veno-occlusive dysfunction competence but does not necessarily signify a normal penil e arterial system. The CIS test should be combined with color Doppler ultrasonography in order to determine the vascular component of ED, si nce the differentiation is not possible between slight penile arterial insufficiency and psychogenic or neurogenic impotence with the CIS te st.