SIMPLE, NONINVASIVE, RISK-FREE DIFFERENTIAL DIAGNOSIS OF VASCULOGENIC IMPOTENCE

血管发生性不全可以通过注射血管活性药物盐酸罂粟碱进行诊断，但这并不能使诊断者确定是传入动脉系统还是外循环静脉系统受损。在这项研究中，我们采用了一种技术，使我们能够确定这两个系统中的哪一个受损。为了检测传入动脉系统，用TC-99 m标记的人血清白蛋白静脉注射阴茎海绵体，用γ照相机产生时间依赖性的闪烁信号，在感兴趣区建立阴茎血流动力学曲线。阴茎海绵体内注射罂粟碱同时记录阴茎海绵体收缩曲线和阴茎周长及刚性的变化。第二代抗生素头孢替安在体内不能与罂粟碱一起代谢并呈代谢模式（r=0.82，p<0.01）与罂粟碱极为相似，将其注入阴茎，测定其在外周血中的时间依赖性浓度。对罂粟碱负荷的PENOVELS曲线的反应同时用PENOVELS指数（PI）表示，头孢替安的清除率用头孢替安清除指数（CCI）表示。将上述指标与阴茎勃起度进行比较，PI值为75.5 ± 0.5SY。（）8.4为紧立组和46.8（）SY.+-.勃起不全组PI为16.0，无勃起组PI为40.5 ± 0.5。（）10.4.与完全勃起组相比，不完全勃起组和非勃起组的PI显著降低。参考彩色多普勒血流计显示的阴茎动脉变化，当患者的PI低于正常值60时，我们诊断患者为动脉源性阳萎。最后，CCI在组间无显著差异，可能是因为CCI受传入血流量和速率的影响。

VASCULOGENIC IMP0TENCE CAN BE DIAGNOSED BY INJECTING THE VASOACTIVE DRUG, PAPAVERINE HYDROCHLORIDE, INTRACAVERNOUSLY, BUT THIS DOES NOT ENABLE THE DIAGNOSTICIAN TO DETERMINE WHETHER THE AFFERENT ARTERIAL OR EFFERENT VENOUS SYSTEM IS IMPAIRED.IN THIS STUDY, WE DEVELOPED A TECHNIQUE THAT ENABLES US TO DETERMINE WHICH OF THESE TWO SYSTEMS IS INVOLVED.TO TEST FOR THE AFFERENT ARTERIAL SYSTEM, TC-99m LABELED HUMAN SERUM ALBUMIN WAS ADMINISTERED INTRAVENOUSLY TO THE CORPUS CAVERNOSUM PENIS TO PRODUCE A TIME-DEPENDENT SCINTIGRAM USING A GAMMA CAMERA.THE REGION OF INTEREST WAS SET UP TO DELINEATE PENILE HEMODYNAMICS AS A PENOGRAM CURVE.AFTER ISOTOPE INJECTION, PAPAVERINE WAS ADMINISTERED INTO THE CORPUS CAVERNOSUM PENIS TO SIMULTANEOUSLY RECORD CHANGES IN BOTH THE PENOGRAM CURVE AND PENILE CIRCUMFERENCE AND RIGIDITY.THE SECOND GENERATION ANTIBIOTIC CEFOTIAM, WHICH CANNOT BE METABOLIZED IN VIVO TOGETHER WITH PARAVERINE AND SHOWS AN EFFERENT PATTERN (r=0.82, p<0.01) EXTREMELY SIMILAR TO THAT OF PAPAVERINE, WAS ADMINISTERED INTO THE PENIS TO MEASURE ITS TIME-DEPENDENT CONCENTRATIONS IN PERIPHERAL BLOOD.THE RESPONSE OF THE PENOGRAM CURVE TO PAPAVERINE LOADING WAS EXPRESSED SIMULTANEOUSLY IN A PENOGRAM INDEX (PI), AND THE CEFOTIAM EFFERENCE INDICATED AS A CEFOTIAM CLEARANCE INDEX (CCI). THESE INDICES WERE COMPARED WITH THE DEGREE OF ERECTION.THE PI WAS 75.5 (〕SY.+-.〔) 8.4 FOR THE COMPLETE -ERECTION GROUP AND 46.8 (〕SY.+-.〔) 16.0 FOR THE INCOMPLETE-ERECTION GROUP.THE PI OF THE NON-ERECTION GROUP WAS 40.5 (〕SY.+-.〔) 10.4. THE PI DECREASED SIGNIFICANTLY FOR THE INCOMPLETE-ERECTION AND NON-ERECTION GROUPS, COMPARED TO THE COMPLETE-ERECTION GROUP.WITH REFERENCE TO CHANGES IN PENILE ARTERIES SHOWN USING A COLOR DOPPLER FLOWMETER, WE DIAGNOSED PATIENTS AS HAVING ARTERIOGENIC IMPOTENCE WHEN THEIR PI WAS LESS THAN THE NORMAL VALUE OF 60. IN CONTRAST, THE CCI SHOWED NO SIGNIFICANT DIFFERENCE BETWEEN GROUPS, PROBABLY BECAUSE THE CCI WAS AFFECTED BY THE AFFERENT BLOOD FLOW VOLUME AND RATE.