[Penile Doppler ultrasound: contribution to the management of erectile dysfunction]. / Le pharmaco-écho-doppler pénien: quel rôle dans la prise en charge d'une dysfonction érectile?

Erectile dysfunction (ED) is a common multifactorial disease, in most situations arising from an organic or mixed cause. Most cases of ED classified as arterial are linked to endothelial dysfunction in relation to the key factors of cardiovascular risk. ED is an indicator of vascular health in general. It is also a predictor of cardiovascular events, including coronary heart disease. It has also been associated with lower peripheral arterial disease and stroke. At the present time, penile Doppler ultrasound examination is relatively little used in the management of ED, knowledge of the etiologic factors being most often not necessary for therapeutic management, but also because of the absence of standardization. Nonetheless, recent large-scale studies have shown that the vascular nature of ED, based on Doppler parameters recorded after intracavernous injection of vasoactive drugs, was also predictive of cardiovascular events and cardiovascular mortality, warranting greater interest in this test.

[A critical study of the penile Doppler test. Considerations apropos of a personal series of over 850 patients tested for the evaluation of impotence since 1983]. / Etude critique de l'examen Doppler pénien. Réflexions à propos d'une série personnelle de plus de 850 patients examinés pour bilan d'impuissance depuis 1983.

The penial Doppler is, in 1990, the first intention examination the most asked for when there is a suspicion of a vascular origin in an erection problem. In fact, due to the technical difficulties to carry it out, this examination presents many uncertainties in its interpretation, and can even be the source of diagnostic errors. The aim of this study is to argue in favour of a systematic intracavernous injection of 8 mg of papaverine when the penial Doppler is carried out, enabling an increase in its diagnostic value and often a therapeutic orientation straightaway.

[Percutaneous transluminal angioplasty of the terminal abdominal aorta. Apropos of a case with a review of the literature]. / Angioplastie transluminale percutanée de l'aorte abdominale terminale. A propos d'une observation avec revue de la littérature.

The indications and results of peripheral arterial angioplasty have now been well defined. The application of this technique to lesions of the infra-renal abdominal aorta has not been particularly controversial up until now but very few cases have been reported in the literature. The authors report a new case using the technique of a double balloon inserted into the two femoral arteries. Apart from the advantages of angioplasty, this technique appears to avoid the risk of impotence inherent with aorto-iliac surgery. The use of Road-Mapping simplifies the problems of detection, position, and adaptation of the balloon and reduces the duration of the procedures.

[Significance of the penile pressure index and value of the papaverine mini-test (8 mg)]. / Signification de l'indice de pression pénien (I.P.P.) et intérêt du mini-test á la papavérine (8 mg).

The main non invasive test to quantify arteriogenic impotence is the penile blood pressure (P.B.P.I.). However, its signification is still in discussion. In this work, after discussion of the previous literature, we have revisited the P.B.P.I. signification by quoting it in comparison to the dynamic tests of erection (artificial erection, papaverine test, nocturnal penile tumescence (N.P.T.) with the findings of arteriography. A series of 51 cases having been studied with the multidisciplinary evaluation that we recommend were analyzed and compared to the location of the arterial lesions (aorto-iliac and/or internal pudendal) and to the response to the 80 mg papaverine test (rigidity and initial intracavernous flow (I.I.F.). A significant difference (p less than 0.05) for P.B.P.I. has been demonstrated between normal arteriograms and bilateral lesions. The P.B.P.I. is significantly lower when the lesions are located to the main arteries and bilateral. I.I.F. helps to differentiate hemodynamically severe arterial lesions where surgery is recommended from mild lesions where intracavernous drugs are first proposed. After discussion of the risks of the 80 mg papaverine test in unspecialized units, the authors propose a standardized method to evaluate the penile arteries, using the Doppler and the 8 mg papaverine mini-test which does not carry the risks of prolonged erection. This approach allows a precise morphologic and hemodynamic evaluation for the arterial impotence.

[Dimensions, volume and rigidity of the penis. Fundamental elements in the study of the erection and its dysfunctions]. / Dimensions, volume et rigidité de la verge. Eléments fondamentaux de l'étude de l'érection et de ses dysfonctions.

The length and the proximal and distal circumferences of the flaccid and erect penis were measured as part of the aetiological investigation of 62 impotent patients. These measurements, compared with the quantitative study of penile rigidity, demonstrate the lack of correlation between circumference changes and rigidity and constitute a simple method for the measurement of penile volume variations and, when compared with penile rigidity, provide important information concerning the physiology of erection and its dysfunction.

Is impotence an arterial disorder? A study of arterial risk factors in 440 impotent men.

The distribution of four main arterial risk factors (ARF) (diabetes, smoking, hyperlipidaemia (HLP), and hypertension) was investigated in 440 impotent men (mean age 46.8) in whom the penile blood-pressure index (PBPI) (ie, the ratio of the lowest systolic pressure in one of the four main arteries of the penis to the systolic pressure in the arm) was measured. In 222 the cause (organic or functional) of impotence was sought by further investigations, such as cavernosonography. 80% of this subgroup had organic impairment of erection. In 53% of these there was evidence of an arterial lesion. Smoking (64%), diabetes (30%), and HLP (34%) were all significantly more common in the 440 impotent men than in the general male population of a similar age. Whenever two or more ARFs were present mean PBPI was significantly lower. The frequency of organic impotence increased from 49% in the absence of any ARF to 100% in patients with 3 or 4 ARFs. It is concluded that increase in the frequency of impotence with age is mainly related to arteriosclerotic changes for the arteries of the penis and that the ARF and PBPI should be evaluated first in any patient complaining of impotence.