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Myron I. Murdock, M.D., F.A.C.S.
Special Diagnostic Tests: Basic blood studies including blood count, CBC, chemical profile, and hormone tests including the male hormones testosterone, total and free, prolactin, and the pituitary leutinizing hormones (LH) and follicle stimulating hormone (FSH) are frequently drawn on a routine basis. General illness can be determined from the red and white blood counts. Kidney and liver function which can affect sexual function are determined by certain chemical evaluations such as the BUN, creatinine, and various enzyme studies including the bilirubin. Diabetes can be ruled out or questioned based upon the blood sugar level, and obviously patients who have elevated cholesterols and triglycerides run a greater risk of high blood pressure and hardening of the arteries. Thyroid tests may also sometimes be needed. The levels of the male hormone, testosterone, should absolutely be obtained in patients who have poor sexual desire since most impotent men with normal hormone levels have normal desire . Desire problems are frequently found in patients with elevated prolactins, low testosterone, or those with psychogenic causes for their erectile dysfunction.
Nocturnal Penile Tumescence (NPT or Rigiscan Sleep Studies): Sleep studies, in general, should only be performed in younger males, i.e. less than sixty years of age, in which the etiology of the impotence is not obvious and all patients, no matter what their age, if there is a need to differentiate psychological from organic causes for the sexual dysfunction. Sleep studies are based upon the principle that all men from birth to death, have erections of a certain intensity and rigidity, lasting fifteen to thirty minutes, roughly every ninety minutes during the night. Patients with a psychological cause for their impotence will have normal sleep erection cycles, whereas patients who have a physical cause (organic) will have some abnormality of the frequency, intensity or duration of their sleep erections. Other ways of measuring sleep erections would include the stamp test in which a roll of stamps are placed around mid-shaft of the penis with the sticky side out for two to three nights to see if the stamps break, indicating at least one good erection. A more sophisticated simple test called the Snap Gauge manufactured by Dianon Corporation indicates that there is one good erection at night, but also determines the strength of the erection, i.e., weak, moderate, or strong. In general, Rigiscan sleep studies are the best way of determining what the nocturnal erection sleep cycle is. Men can have one good erection at night, but this is, in fact, not normal, since most men have three to five erections at night. Snap Gauge and stamp tests will only demonstrate one erection and cannot quantitatively demonstrate the other erections at night.
Cavernosometrics and Cavernosography In very unusual and rare situations, where the doctor suspects that the veins in the penis drain the blood too rapidly, preventing or deflating an erection, one may do cavernosometry and cavernosography to demonstrate a venous leak. In cavernosometry, an erection is induced with injectable drugs and saline is pumped into penis. The rate of saline flow necessary to maintain the erection may determine the presence of a venous leak. If a leak is suspected, cavernosography may be performed. Contrast dye is injected into the penis, and x-rays taken to see if the leakage is focal and surgically correctable, or as in most situations, a diffuse leak which is not correctable. Most cases of what appears to be a venous leak problem are due to arterial insufficiency, and the treatment of the venous leak is by increasing the blood flow into the penis by therapies including Viagra, intraurethral Prostaglandin (Muse), and/or intracavernosal injections of drugs such as Prostaglandin E-1 (Caverject).
Pudendal Angiography In those rare and unusual cases in which a relatively young male, under 55 years of age has a history of pelvic trauma from an vehicular or other accident in which the pelvis was fractured, or a straddle injury, or occasionally in intense cyclists, the pudendal arteries may be injured. Doppler flow sonographic studies of the penile blood flow would confirm decreased penile blood flow. If it was felt that arterial reconstructive surgery might be helpful, Pudendal angiography or x-rays of the blood vessels supplying the penis would be needed. Surgical arterial reconstruction is successful only in a rare traumatic patient. Arterial reconstructive surgery for impotence is usually unsuccessful for most patients who are elderly, or already have small vessel vascular disease, or are diabetic. Doppler flow studies and angiography would not be done in most of these circumstances. [Back] [Treatment Options] <-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
Rev:03/08 |