Improving the Accuracy of Hemodynamics Using a Vasoactive Medication Re-dosing during Dynamic Infusion Cavernosometry and Cavernosography

Purpose: Dynamic infusion cavernosometry and cavernosography (DICC) is a recognized technique for evaluating the hemodynamics of an erection. During DICC, complete corporeal smooth muscle relaxation is essential for obtaining accurate data. A means of promoting maximal smooth muscle relaxation is repeat doses of vasoactive medication during vascular testing. The effect of re-dosing with vasoactive medication on the hemodynamics was investigated in impotent men undergoing DICC. Materials and Methods: A total of 81 patients having undergone DICC, between January 2002 and December 2003, were prospectively reviewed. When the veno-occlusive parameters were abnormal, the intracavernous vasoactive agent dose was repeated a maximum of 3 times. Arterial insufficiency was diagnosed when the cavernosal artery systolic occlusion pressure was less than 100mmHg or more than 30mmHg below brachial arterial pressure. Venous leakage was diagnosed when the flow-tomaintain value was greater than 3ml/min or the pressure decay was greater than 45mmHg/30sec. The proportion of men in whom the vascular diagnosis had altered was analyzed using this regimen. Results: Of the 81 subjects, 69 (85.2%) warranted re-dosing based on their abnormal veno-occlusive parameter. Of these 69 patients, the venoocclusive values were corrected in 22 (31.9%) by repeat medication; therefore, they would have been falsely diagnosed with venous leakage during vascular evaluation. 13 patients (59.1%) of all corrections occurred with the second dose, while 9 patients (40.9%) of the patients required a third dose of medication. Conclusions: Re-dosing with a vasoactive agent should be considered during vascular evaluation where incomplete corporeal smooth muscle relaxation is suspected. This approach increases the likelihood of a more accurate diagnosis and decreases the risk of a false diagnosis of venous leakage.