In animal models, direct intracavernosal injection of recombinant VEGF protein or adenoviral VEGF that contains plasmids has shown dramatic results based on cavernosography
Specialised tests for assessing aetiology include nocturnal penile tumescence and rigidity, dynamic duplex ultrasound, dynamic infusion cavernosometry, cavernosography
internal pudendal arteriography and biothesimetry.
Penile ultrasonography, cavernosography
and magnetic resonance imaging can help in the diagnosis of PF (2).
1) The other diagnostic methods, which are more invasive than NPT test, are color Doppler sonography, dynamic cavernosometry, and cavernosography
In all ED patients, we advise vasoactive drugs injection in corpus spongiosum in office, before color Doppler sonography of penis as well as cavernosography
and cavernosometry, also Rigiscan as needed.
Urethrography and cavernosography
imaging in a small series of penile fractures: A comparison with surgical findings.
Evaluation and treatment of penile fractures: Accuracy of clinical diagnosis and the value of corpus cavernosography
Therefore, additional diagnostic imaging modalities, such as cavernosography
and sonography, are often unnecessary and are often best reserved for cases where the diagnosis is unclear or the history is not typical.
Vascular Laboratory: Noninvasive cerebrovascular studies of extracranial arteries; Carotid function - non-invasive tests: Duplex scan of carotid arteries; vertebral arteries; Ocular Plethysmography (OPG) and Ophthalmodynamometry; Transcranial doppler, Penile doppler and Corpora Cavernosography
, Peripheral arterial non-invasive studies: Segmental Doppler Pressures and Pulse Volume Recording; Exercise (Stress) Doppler Test; Visceral arterial duplex imaging; Peripheral Arterial Duplex Scan; Digital Arterial Evaluation; Peripheral venous and arterial non-invasive studies/ultrasonography; Peripheral Arterial Ultrasound Examination Using Pulsed Doppler; AcuTect/Scintigraphic Imaging For Detection/Localization of Lower Limb Deep Vein Thrombosis;-- Hemorheograph.
However, MRI and cavernosography
are mostly recommended to depict discontinuity of the tunica albuginea and diagnose the penile fracture.
If the ultrasound is abnormal, however, arteriography and dynamic infusion cavernosometry and cavernosography
should be performed only in patients who are potential candidates for vascular reconstructive surgery--these tests though are rarely used in current Canadian ED treatment.
These patients are often diagnosed by the failure of vasoactive drugs to induce an erection and/or through cavernosography