Elsevier

Urology

Volume 57, Issue 4, April 2001, Pages 623-626
Urology

Rapid communication
Sildenafil citrate for penile hemodynamic determination: an alternative to intracavernosal agents in Doppler ultrasound evaluation of erectile dysfunction

https://doi.org/10.1016/S0090-4295(01)00923-2Get rights and content

Abstract

Objectives. To suggest a new noninvasive method for penile Doppler ultrasound (PDU) evaluation of erectile dysfunction using oral sildenafil citrate as an erection induction agent.

Methods. A total of 20 patients admitted with the complaint of erectile dysfunction were evaluated by the short form of the International Index of Erectile Function. A total score of less than 25 was accepted as erectile dysfunction and PDU was performed. The initial penile study consisted of PDU examination under visual sexual stimulation (VSS), and the peak systolic velocity, end-diastolic velocity, and resistance index were recorded. Measurements of all the parameters were repeated on the same patients after intracavernosal papaverine, intracavernosal prostaglandin E1 (PGE1), and oral sildenafil citrate administration, plus VSS. All patients had these four tests in the same order at weekly intervals. Sildenafil citrate was given orally 45 minutes before Doppler investigation, and patients had VSS during the waiting period. The patients were asked about their satisfaction and comfort after each test. Statistical analysis was performed using the Wilcoxon and Mann-Whitney U tests.

Results. The measurements with papaverine, PGE1, and sildenafil citrate were significantly different from those after only VSS (P <0.008); however, the papaverine, PGE1, and sildenafil citrate results were not different from each other according to the peak systolic velocity, end-diastolic velocity, and resistance index measurements (P >0.008). Patients commented that although PGE1 was the strongest erectogenic agent, sildenafil citrate was the most convenient.

Conclusions. Since the results of PDU with oral sildenafil citrate in association with VSS were not statistically different, we suggest a new noninvasive erection induction method for the purpose of PDU evaluation of erectile dysfunction.

Section snippets

Material and methods

All patients admitted with erectile dysfunction underwent a pretreatment evaluation with a detailed history and physical examination followed by the short form of the International Index of Erectile Function (IIEF).11 A total of 20 patients who had a likelihood of having an organic etiology and with an IIEF score below 25 were included in the study group. A hormonal profile and serum multiple analysis-12 (SMA-12) were obtained from all patients. Patients older than 50 years or with a history of

Results

The study group consisted of 20 patients between 41 and 64 years of age (average 51.88 ± 2.59). The average IIEF score recorded was 12.47 ± 2.64. The distribution of our patients according to their IIEF score is shown in Table I.

The mean PSV, EDV, and RI values are shown in Table II. The differences between the PSV (P = 0.000), EDV (P = 0.004), and RI (P = 0.0013) values were statistically significant according to the Wilcoxon test. The Mann-Whitney U test was used to discover the source of

Comment

Currently, penile vascular pathologic features can best be detected with pharmacodynamic PDU investigation. However, false-negative results occur when the vasoactive agent injections cause adrenergic tonus changes.3 To avoid the adrenergic effect, PDU with repeated doses of vasoactive agents has been described.12

However, intracavernosal vasoactive agents, namely papaverine, PGE1, and phentolamine, have not been free of complications. The main complications have been prolonged erection and

Conclusions

Since the PDU measurements obtained with oral sildenafil citrate plus VSS were not statistically different from those obtained after penile injections of papaverine and PGE1 on the same patients, we believe that oral sildenafil citrate induces a sufficient erection for obtaining the penile hemodynamic parameters and is a noninvasive test. Our findings suggest that sildenafil citrate when combined with VSS may be used as a first-line diagnostic test in the evaluation of erectile dysfunction,

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