Diagnosis of
Erectile Dysfunction
The diagnosis of organic erectile dysfunction involves a comprehensive evaluation to identify underlying physical causes. Here are some common methods used in the diagnostic process:
Sexual history: A thorough sexual history is a crucial component in diagnosing erectile dysfunction, as it provides comprehensive insights into the underlying causes and contributing factors. This history includes detailed information about the onset, duration, and severity of ED symptoms, as well as the patient’s sexual habits, libido, and satisfaction levels. It also encompasses relationship dynamics, emotional well-being, and any psychological stressors that might affect sexual performance. Additionally, a sexual history helps identify lifestyle factors such as alcohol and drug use, smoking, and exercise habits that could influence erectile function. Understanding the patient’s sexual history allows healthcare providers to differentiate between psychological and organic causes of ED, tailor diagnostic evaluations, and develop personalized treatment plans that address both the physiological and psychosocial aspects of the condition. This comprehensive approach ensures a more accurate diagnosis and effective management of erectile dysfunction.
Medical history: A thorough medical history helps identify risk factors such as diabetes, hypertension, cardiovascular disease, neurological disease, hormonal disease, medication use, and past surgeries or injuries that may contribute to erectile dysfunction.
Physical examination: A thorough physical examination, including evaluation of the penis and testicles, can reveal any anatomical abnormalities, signs of vascular or neurological problems, or other physical factors that contribute to erectile dysfunction.
Blood tests: Blood tests may be done to assess hormone levels (especially testosterone), blood sugar levels (for diabetes), lipid profile (cholesterol levels), and markers of inflammation or other systemic conditions that could contribute to erectile dysfunction.
Penile ultrasound and triplex: This imaging technique uses ultrasound to assess blood flow in the penile arteries. It helps identify arterial insufficiency or other vascular problems that contribute to erectile dysfunction.
Nocturnal erection recording (NPTR): The test involves tracking nocturnal erections using a device called RigiscanTM. Healthy men, unlike those with an organic problem, usually experience multiple erections during sleep, which can help differentiate between psychological and organic causes of erectile dysfunction.
Intrapenile injection of vasodilator drugs: The urologist injects a vasodilator drug directly into the penis to assess vascular function and determine if blood flow problems are contributing to erectile dysfunction. Usually, it is part of the penile triplex which is described in details below.
Dynamic Cavernosometry and cavernosography (DICC): This invasive procedure involves injection of a vasodilator into the penis to assess blood flow and assess the integrity of the penile vessels.
Neurological testing: Electromyography (EMG), nerve conduction studies, and other neurological tests may be performed to evaluate nerve function and identify any neurological disorders that contribute to erectile dysfunction.
Dynamic Triplex of the Penis
It is the most important and most specialized diagnostic test for revealing the causes of erectile dysfunction. It takes about 1 hour and the Urologist must have special training and extensive experience.
What is the dynamic triplex of of the penis?
It is a special diagnostic test that allows the Urologist to diagnose the existence of an erectile vascular problem and at the same time to check the quality of the erectile tissue. The examination is performed with a special ultrasound machine, a special high-frequency probe (14 MHz) and with a linear array of transducers that achieve the production of high-definition images of small structures, such as those of the corpora cavernosa and the vessels of the penis. The test is always performed with a previous injection of vasoactive substances that cause an erection, which is why it is called dynamic triplex of the penis.
How is the triplex of the penis performed?
The patient lies on the medical bed and the doctor performs an ultrasound of the penis to check the condition of the tissue of the two corpora cavernosa.
Then a pharmaceutical erection is induced, i.e. the Urologist administers through a 1ml syringe with a very fine needle (same as the one used by diabetics to administer insulin) vasoactive substances that cause relaxation of the smooth muscle fibers of the corpus cavernosum. The injection causes only mild discomfort to the patient, since it is practically painless and lasts a few seconds.
There are three substances used for this purpose: alprostadil, phentolamine and papaverine. Immediately after the injection, the Urologist places the special ultrasound probe on the penis, and continuously records the blood flows in the cavernous arteries of the penis (usually every 5-10 minutes, until the response to the drug stabilizes, i.e. erection).
This special probe enables real-time recording of both the anatomy of the corpora cavernosa and the arteries of the penis, as well as the evolution of the flows within the arteries (response to vasoactive drugs that cause an increase in flow, similar to that observed during sexual intercourse stimulation).After the end of the examination, the patient remains in the doctor’s office until the penis returns to a resting phase, i.e. the erection is lost.
It normally takes 5-10 minutes to produce a full erection. The time to achieve an erection depends both on the condition of the penile vessels and on the patient’s anxiety during the examination. In case of failure to achieve an erection, a new dose of medication will be administered again in order to achieve a full erection.
The examination lasts from 45 – 90 minutes, depending on the patient’s response to the drugs. The usual time is 1 hour.
What are the 4 typical diagnoses of the dynamic triplex of the penis?
- endothelial dysfunction, in which an erection is achieved, but the response to the stimulus is delayed (an event that causes anxiety in the patient, with consequent loss of the partial erection that may have been achieved).
- arterial insufficiency of the cavernous and helicine arteries of the penis, where, due to damage to the arteries, blood flow to the cavernous bodies is reduced and the erection lacks hardness.
- dysfunction of the veno-occlusive mechanism (venous leakage), where the veins do not close sufficiently to trap blood within the corpora cavernosa of the penis and maintain erection hardness
- mixed vascular problem (arterial insufficiency and venous leakage), usually in patients with multiple cardiovascular risk factors (diabetes, coronary disease, hypertension, hypercholesterolemia, etc.).
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