Male Sexual Dysfunction Role of Nocturnal Penile Erection Test on Response to Daily Sildenafil in Patients With Erectile Dysfunction due to Pelvic Fracture Urethral Disruption: A Single-center Experience Jing Peng, Zhichao Zhang, Wanshou Cui, Yiming Yuan, Bing Gao, Weidong Song, and Zhongcheng Xin OBJECTIVE METHODS
RESULTS
CONCLUSION
To evaluate the results of nocturnal penile erection test and response to daily sildenafil in patients with erectile dysfunction (ED) due to pelvic fracture urethral disruption. From January 2010 to January 2012, we included 38 patients with ED due to pelvic fracture urethral disruption. The mean age was 33.1 years (range, 22-49 years). All were evaluated subjectively and objectively by the International Index of Erectile Function-5, nocturnal penile tumescence and rigidity (NPTR) test, and penile Doppler ultrasonography. Patients received daily sildenafil 50 mg for 3 months. Thirty-one patients were followed up: 54.8% showed response to sildenafil defined as reporting successful vaginal penetration and intercourse. Patients with neurogenic, arterial, and venous EDs did not differ in efficiency rates (P ¼ .587). However, the penile erectile rigidity recorded by NPTR test affected efficiency significantly (P ¼ .046). Patients with tip rigidity >40% had the highest response rate (76.9%), but the response rate for patients with tip rigidity 10 minutes with rigidity at the penile tip of at least 60%.8 Patients with significant ED on NPTR testing were further evaluated by duplex ultrasonography of the cavernous arteries with intracavernous injection of prostaglandin E1 10 mg after the third night to determine the causes. Ultrasonography was performed 15 minutes later after injection plus genital and audiovisual sexual stimulation to help with smooth muscle relaxation. Duplex ultrasonography demonstrated arterial and venous blood flow. Arterial peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index were recorded. A PSV 25 cm/s, RI 0.8, and EDV 5 cm/s were considered normal.9 PSV 25 cm/s but EDV >5 cm/s and RI
RESULTS
CONCLUSION
To evaluate the results of nocturnal penile erection test and response to daily sildenafil in patients with erectile dysfunction (ED) due to pelvic fracture urethral disruption. From January 2010 to January 2012, we included 38 patients with ED due to pelvic fracture urethral disruption. The mean age was 33.1 years (range, 22-49 years). All were evaluated subjectively and objectively by the International Index of Erectile Function-5, nocturnal penile tumescence and rigidity (NPTR) test, and penile Doppler ultrasonography. Patients received daily sildenafil 50 mg for 3 months. Thirty-one patients were followed up: 54.8% showed response to sildenafil defined as reporting successful vaginal penetration and intercourse. Patients with neurogenic, arterial, and venous EDs did not differ in efficiency rates (P ¼ .587). However, the penile erectile rigidity recorded by NPTR test affected efficiency significantly (P ¼ .046). Patients with tip rigidity >40% had the highest response rate (76.9%), but the response rate for patients with tip rigidity 10 minutes with rigidity at the penile tip of at least 60%.8 Patients with significant ED on NPTR testing were further evaluated by duplex ultrasonography of the cavernous arteries with intracavernous injection of prostaglandin E1 10 mg after the third night to determine the causes. Ultrasonography was performed 15 minutes later after injection plus genital and audiovisual sexual stimulation to help with smooth muscle relaxation. Duplex ultrasonography demonstrated arterial and venous blood flow. Arterial peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index were recorded. A PSV 25 cm/s, RI 0.8, and EDV 5 cm/s were considered normal.9 PSV 25 cm/s but EDV >5 cm/s and RI
