title: A comparison between portable ultrasound (MIDUS) and nocturnal RigiScan when confirming the diagnosis of vascular organic erectile disorder.
abstract: In recent years, the use of RigiScan and ultrasound to assess erectile dysfunction has fallen from favour. However, in a small minority of specialist cases, where a vascular, neurogenic or psychogenic aetiology requires confirmation, there remains a need for further investigation. To establish if in a preliminary assessment the use of nocturnal RigiScan or male impotence diagnostic ultrasound system (MIDUS) represents best practice as a diagnostic investigation in patients with a history suggestive of vascular organic erectile disorder. Men attending both urological and psychosexual therapy clinics with erectile dysfunction were assessed using a generic assessment schedule. Patients with a history suggestive of vascular erectile disorder were offered the opportunity of dual investigation of their condition. After screening using a provocative RigiScan using visual stimuli that gleaned inconclusive results, patients were offered the chance to enter a study with both nocturnal RigiScan and MIDUS investigation. These were confined for the purposes of this study to RigiScan events, peak systolic flow velocity (PSV) and end-diastolic flow velocity (EDV) from ultrasound examination where an abnormal EDV is defined as in excess of 4.5 cm/s and a normal PSV is variously defined as being greater than 35 cm/s. In all, 38/43 (88%, 95% CI: 76-95%) of men had a nocturnal event exceeding 3 min on the RigiScan investigation. This compares with 17/43 (40%, 95% CI: 26-54%) of men with a normal EDV blood flow of less than 4.5 cm/s (P<0.017) and 32/43 (74%, CI: 60-85%) of men with a normal PSV flow greater than 35 cm/s (NS). Rigiscan and ultrasonography of the cavernosal vessels are of equal usefulness in suspected arterial penile disease although where veno-occlusive disease is suspected, ultrasonography is more specific.
authors.affiliation: Sexual Medicine, Porterbrook Clinic, Nether Edge, Sheffield, Yorkshire, UK. research@porterbrookclinic.org.uk
authors.forename: K R
authors.initials: KR
authors.lastname: Wylie
authors.forename: D
authors.initials: D
authors.lastname: Davies-South
authors.forename: D
authors.initials: D
authors.lastname: Steward
authors.forename: S
authors.initials: S
authors.lastname: Walters
authors.forename: M
authors.initials: M
authors.lastname: Iqbal
authors.forename: S
authors.initials: S
authors.lastname: Ryles
mesh_terms: D000328:Adult; D000368:Aged; D002940:Circadian Rhythm; D003950:Diagnostic Techniques, Urological / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D018783:Impotence, Vasculogenic / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D014463:Ultrasonography