Radiology, Vol 164, 175-178, Copyright © 1987 by Radiological Society of North America
Cavernosal venocclusive insufficiency in male impotence: evaluation of degree and location
JJ Bookstein
The author's experience with 72 patients with impotence, one patient with
Peyronie disease (no impotence), and two healthy volunteers indicates that
incompetence of the venocclusive mechanism of the corpora cavernosa is
probably the most common cause of vasculogenic impotence. Manometric and
angiographic studies are the key to diagnosis but only when performed while
the venocclusive mechanism is activated. Activation is achieved by
intracavernosal injection of a papaverine- phentolamine mixture.
Pharmacomanometry, performed with the newly developed pharmacologic
maintenance erectile flow (PMEF) method, enabled precise quantitation of
the leak at a given cavernosal pressure. A new appreciation of the limited
volume of normal flow in the cavernosal arteries indicates that cavernosal
leak in the range of only 20 ml/min is probably capable of contributing to
impotence. Pharmacocavernosography enabled identification of sites of
leakage (key information in the planning of surgical correction) but was
unreliable in the evaluation of the severity of leakage.
