BULBOCAVERNOSUS REFLEX STUDIES AND AUTONOMIC TESTING IN THE DIAGNOSISOF ERECTILE DYSFUNCTION

The electrophysiologic evaluation of patients with erectile dysfunctio n presents an important diagnostic challenge. The bulbocavernosus refl ex (BCR) latency has been commonly used to evaluate these disorders, H owever, it is a measure of somatic penile innervation, whereas erectio n is primarily dependent on autonomic function. We evaluated 195 men w ith erectile dysfunction over a 3 year period, Each had electrophysiol ogic studies, nerve conduction studies and a BCR. ECR studies were abn ormal in only 7%, of which most had diabetes or pelvic trauma. The BCR was the sole electrophysiologic abnormality in only 2%. Autonomic tes ting (AT) was additionally performed in 19 diabetic and 23 non-diabeti c patients. This included sympathetic skin responses and measurement o f the Valsalva ratio and heart rate variability with 6/min breathing. In the diabetic group, AT was positive in 63%, and most often was the sole abnormality. The bulbocavernosus reflex is relatively insensitive in the diagnosis of erectile dysfunction. Brief autonomic testing may provide valuable additional data, particularly in diabetics. (C) 1938 Elsevier Science B.V.