Impotence men’s special examination
Male erectile dysfunction a special inspection
⑴ Psychological Testing: Minnesota Multiphasic Personality Inventory (MMPI), Derogatis sexual function questionnaire, the California Personality Inventory scales in differentiating psychogenic and organic erectile dysfunction with a reference value, but can not serve as an important basis.
⑵ nocturnal penile enlargement test (nocturnal penile tumescence, NPT): 1970 Nian Karacan the first to use the natural nocturnal penile erection physiological phenomenon of psychological identification and organic Yang fistula. The pilot and less susceptible to psychological factors, can respond in a more objective erectile function. Normal in the fast-moving sleep state, the erection of 4 ~ 6 times per night, sustained 25 to 40 minutes. To Hardness Tester (rigiscan) monitoring the hardness of up to 65% ~ 70%, but this test is still 15% ~ 20% false-negative.
⑶ listen to visual sexual stimulation test (audiovisual sexual stimulation, ASS): watching the sex video of sexual stimulation, to monitor changes in the penis. The more close to physiological conditions to understand the penile erection ability, but often need to monitor the collaboration with the NPT to conduct a comprehensive analysis of those involved.
⑷ penile blood flow test: the penis is a vascular disease caused by an important cause of organic erectile dysfunction, or arterial and venous occlusion barrier mechanism disorders.
Vasoactive drug-induced erection test: At present, many using of papaverine 30 ~ 60mg, phentolamine pull a 1 ~ 2mg or prostaglandin E20μg, alone or in combination. Intracavernous drug injected into the penis to achieve a rigid erection, maintenance of more than 30 minutes, indicating that there was no significant vascular lesions, there may be false negative. After injection, accompanied by stimulation of its higher reliability. Occur ecchymosis, hematoma, and complications such as priapism.
Penile Doppler ultrasound monitoring: determination of penile brachial artery blood pressure and arterial blood pressure ratio (PBI). Is less than 0.6 Tips penile artery disorder. Absolute difference between the two systolic blood pressure should not exceed 4kPa (30mmHg).
Penile blood flow index (penile flow index, PFI): the Doppler ultrasonic probe measurement of the radial artery, dorsal penile artery and penile cavernosal artery blood Han index calculated acceleration. PFI <6 Tips penile blood supply to normal.
Penile blood flow pulse Q-capacity record: normal penile blood volume pulse waveform rose rapidly to the top of the peak and then decline slowly notch double-wave pulse. Rounded peak or falling too slow and the double-wave pulse notch disappeared, suggesting that there are blood vessels.
Color duplex Doppler ultrasound detection: detection of cavernous structure, blood vessel diameter, blood flow velocity and vasomotor function dynamically detect the process of penile erection arterial and venous hemodynamic changes, cavernous resistance index is a screening vascular erectile dysfunction the most valuable non-invasive examination methods.
Cavernous perfusion test and cavernosography (dynamic infusion cavernosometry & cavernosography, DICC): usually induce an erection for monitoring perfusion rate (induction flow, IF), the minimum flow rate to maintain an erection (maintenance flow, MF), stop infusion thing within 30 seconds sponge body of the pressure drop gradient (pressure loss, PL). MF, and PL values greater indicates a venous leak erectile dysfunction function. PL normal within 30 seconds should be <3.3kPa (25mmHg), MF should be <20 ~ 40ml/min, IF should be 80 ~ 120ml/min. Cavernosography through the injection of contrast agents observe whether the abnormal venous drainage, when an erection is common to return a few exceptions are: penile deep dorsal vein to the prostatic plexus and the perineum vein, cavernous venous plexus and the perineum to the prostate within the veins, the penis leakage between the corpus cavernosum and corpus spongiosum.
Pudendal artery angiography: suspected impaired penile artery, penile artery reconstruction line through the femoral artery before bilateral pudendal artery angiography to observe both sides of the penile dorsal artery, cavernous artery disease.
⑸ erection nerve detection: nerve in the erectile mechanism plays an important role, so routine testing with an erection causes the nervous system in the diagnosis of vital reason to be, especially had brain, spinal cord, pelvic trauma and diabetes patients with a history.
Bulbocavernosus reflex latency (bulbocavernosus reflex latency ime, BCRL): detection of dorsal penile nerve (afferent) to sacral spinal cord, and then to the ball from the movement efferent cavernous muscle, ischial cavernous anal sphincter muscle and the conduction speed, the normal should be 27 ~ 42ms.