The patient's self-evaluation better predicts the degree of erectile dysfunction than the response to intracavernous alprostadil testing.
OBJECTIVE
A modern baseline assessment of erectile dysfunction (ED) should be individualized, reliable, noninvasive and cost-efficient. Appraisal based on the patient's self-evaluation may be the method of choice.


METHODS
Using a self-report method, 63 consecutive ED patients were prospectively investigated. Semiquantitative parameters on 7 criteria were assessed, and an intracavernous injection test with alprostadil was performed. Performances of self-reporting and intracavernous testing in predicting penetrative ability were compared.


RESULTS
Twenty-three (37%) men had erection insufficient for penetration even with manual assistance, 26 (41%) men needed manual assistance and 14 (22%) could penetrate without manual assistance but erection was not sufficient for satisfaction. In addition to impaired penetrative ability, 6 criteria (intercourse frequency, patient's and partner's satisfaction, penile rigidity, duration of erection and need for extra stimulation) deteriorated over time (p < 0.006). Patient self-evaluation criteria such as intercourse per week, patient satisfaction, penile rigidity, duration of erection and time between consultation and last satisfactory intercourse showed discriminating differences in accordance with the 3 subgroups of penetrative ability (p < 0.02). Intracavernous testing could not reproduce the degree of erectile deficit as experienced during intercourse (p = 0.21). In a logistic regression model, criteria best characterizing penetrative ability were penile rigidity, time between consultation and last unsuccessful intercourse, and degree of satisfaction (p < 0.0001).


CONCLUSIONS
The patient's self-evaluation by semiquantitative parameters on criteria characterizing sexual erections better predicts the penetrative ability than the response to an intracavernous injection. These criteria quantify both the objective degree of ED and the patient's apprehension. Consequently, patients may undergo immediate treatment without further testing.
Casella
Roberto
R
Clinics of Urology, Hospitals of Basel, Switzerland. rcasella@uhbs.ch
Deckart
Alexander
A
Bachmann
Alexander
A
Sulser
Tullio
T
Gasser
Thomas C
TC
Lehmann
Kurt
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000008:administration & dosage; D007172:Erectile Dysfunction / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012648:Self Care; D014665:Vasodilator Agents / Q000008:administration & dosage
D014665:Vasodilator Agents; D000527:Alprostadil