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Diagnosis and Evaluation of Male Erectile Dysfunction Of the thirty million American men with chronic impotence not all need significant and expensive diagnostic evaluations. Patients with an obvious cause for their sexual dysfunction or patients over 60 years of age probably need a minimal amount of diagnostic testing. Most of the tests necessary are blood tests frequently done by their primary care or internal medicine physicians. If there is a sexual desire problem a total testosterone and a prolactin blood test should definitely be performed in addition to the routine blood count and chemical profiles most patients normally have. For this group of patients a trial of Viagra would be best, and if response is good without side effects continuation of the drug should be done. On the other hand, in that group of impotent men who are under 60 years of age and the diagnosis is not obvious, diagnostic testing should be performed to determine the etiology of their sexual dysfunction even if Viagra in the end is an effective form of therapy. Remember, the sexual dysfunction of impotence is a symptom of another problem. Many times the other problem can be resolved which will resolve the sexual dysfunction. In addition, frequently the other problem has medical sequelae that are more dangerous than the impotence. For example, one-third of the patients who have undiagnosed cardiovascular disease and who present with impotence as the first symptom of their cardiovascular problem will have some cardiovascular complication such as a heart attack or stroke within three years of diagnosing or treatment their sexual dysfunction. This group of patients requiring special diagnostic studies should certainly be seen by their urologic specialist who will not only do the routine bloods, CBC and chemistry profile, and the hormone studies, total testosterone, prolactin, and possibly free testosterone with LH and FSH levels, but will seriously consider doing nocturnal penile sleep studies, (NPT or Rigiscan), to determine whether this is a physical or a psychogenic problem. These tests may determine the cause, give a prognosis as to how long treatment may be necessary, and lastly to objectively measure the severity of the problem and assist in determining how much medicine or treatment will be necessary and what doses should be started with. In less than 10% of patients who are young and where the blood studies including hormone tests, are normal the diagnosis is determined to be physical, on the basis of sleep studies (Rigiscan testing). The urologist may then consider more aggressive vascular testing procedures including Doppler flow studies of the penis, angiography, and x-ray pictures of the penis in the erect state using contrast material (cavernosometry) along with penile pressure studies (cavernosometrics). [Back] [Special Tests] <-next |
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[Home] Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc Greenbelt - Bowie - Laurel Maryland (301) 441-8900 Fax (301) 982 0453 7500 Hanover Parkway Suite 206 Greenbelt, MD 20770
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