title: Feasability of a novel audio-video sexual stimulation system: an adjunct to the use of penile duplex Doppler ultrasonography for the investigation of erectile dysfunction.
abstract: BACKGROUND
  Penile color Doppler ultrasonography (CDUS) with pharmacotesting has become an important tool for evaluating vascular erectile dysfunction (ED), and audio-visual sexual stimulation (AVSS) has been suggested to be helpful in assisting the performance of CDUS during the examination.
  
  
  OBJECTIVE
  To investigate the feasibility of using a novel, remotely controllable AVSS system to assist CDUS.
  
  
  METHODS
  This prospective randomized cross-over study recruited 60 consecutive ED patients. Each patient received three randomized sessions of CDUS under different conditions-AVSS, intracavernous injection (ICI) of alprostadil 20 microgram, or AVSS plus ICI. Clinical responses (rigidity) and penile vascular parameters including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured. At the end of the study, patients were asked about how they perceived the AVSS system in generating sexual arousal.
  
  
  METHODS
  PSV, EDV, RI, and rigidity.
  
  
  RESULTS
  Fifty-eight ED patients (aged 21-79) underwent 174 sessions of CDUS. The mean PSV and maximal rigidity of patients under ICI alone were significantly greater than those of patients under AVSS alone (48.25 ± 22.78 vs. 36.54 ± 23.25 cm/second and 65.00 ± 23.93% vs. 43.28 ± 31.79%, respectively; both P < 0.05). The mean PSV of patients under AVSS plus ICI (55.38 ± 28.81 cm/second) was significantly greater than that of patients under ICI alone (P < 0.05), while the mean maximal rigidity (72.50 ± 22.03%) was only marginally greater (P = 0.082). EDV or RI was of no significant difference among the different conditions. Ultrasonographic diagnoses of ED under different conditions varied substantially. Fifty-four (93%) patients considered the AVSS system "very satisfactory" or "satisfactory" in evoking sexual arousal.
  
  
  CONCLUSIONS
  The novel, remotely controllable AVSS system is well accepted by patients and, in conjunction with ICI, helps to produce higher PSV for patients undergoing CDUS.
authors.affiliation: Department of Urology, Yangming Branch of Taipei City Hospital, Taipei, Taiwan.
authors.forename: Yuh-Chen
authors.initials: YC
authors.lastname: Kuo
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Liu
authors.forename: Jyh-Horng
authors.initials: JH
authors.lastname: Chen
authors.forename: Hong-Chiang
authors.initials: HC
authors.lastname: Chang
authors.forename: Vincent F S
authors.initials: VF
authors.lastname: Tsai
authors.forename: Ju-Ton
authors.initials: JT
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage; D001143:Arousal; D001783:Blood Flow Velocity; D018592:Cross-Over Studies; D007172:Erectile Dysfunction / Q000000981:diagnostic imaging*; D004882:Erotica; D005240:Feasibility Studies; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D014665:Vasodilator Agents / Q000008:administration & dosage; D014741:Video Recording
chemical_list: D014665:Vasodilator Agents; D000527:Alprostadil