Feasability of a Novel Audio-Video Sexual Stimulation System: An Adjunct to the Use of Penile Duplex Doppler Ultrasonography for the Investigation of Erectile Dysfunction

Abstract

Introduction Penile color Doppler ultrasonography (CDUS) with pharmacotesting has become an important tool for evaluating vascular erectile dysfunction (ED), and audio-visual sexual stimulation (AVSS) has been suggested to be helpful in assisting the performance of CDUS during the examination. Aim To investigate the feasibility of using a novel, remotely controllable AVSS system to assist CDUS. Methods This prospective randomized cross-over study recruited 60 consecutive ED patients. Each patient received three randomized sessions of CDUS under different conditions—AVSS, intracavernous injection (ICI) of alprostadil 20 microgram, or AVSS plus ICI. Clinical responses (rigidity) and penile vascular parameters including peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured. At the end of the study, patients were asked about how they perceived the AVSS system in generating sexual arousal. Main Outcome Measures PSV, EDV, RI, and rigidity. Results Fifty-eight ED patients (aged 21–79) underwent 174 sessions of CDUS. The mean PSV and maximal rigidity of patients under ICI alone were significantly greater than those of patients under AVSS alone (48.25 ± 22.78 vs. 36.54 ± 23.25 cm/second and 65.00 ± 23.93% vs. 43.28 ± 31.79%, respectively; both P <0.05). The mean PSV of patients under AVSS plus ICI (55.38 ± 28.81 cm/second) was significantly greater than that of patients under ICI alone (P <0.05), while the mean maximal rigidity (72.50 ± 22.03%) was only marginally greater (P = 0.082). EDV or RI was of no significant difference among the different conditions. Ultrasonographic diagnoses of ED under different conditions varied substantially. Fifty-four (93%) patients considered the AVSS system “very satisfactory” or “satisfactory” in evoking sexual arousal. Conclusions The novel, remotely controllable AVSS system is well accepted by patients and, in conjunction with ICI, helps to produce higher PSV for patients undergoing CDUS.

Standardization of Vascular Assessment of Erectile Dysfunction

“…Intermediate values are not specific [9–11]. The angiographic correlation has shown that a velocity threshold above 25 cm/second is 92% accurate in the diagnosis of arterial integrity [10–12].…”

“…Inner diameter of intracavernosal arteries (both left and right) and occasionally the peak systolic velocities (PSVs) in both arteries are then measured using the Doppler blood‐flow mode. Although recent studies claim a good predictive value of PSV measurement in this flaccid state , the universal consensus is to perform the study under pharmacologically induced erection [10–15]. For this, an ICI of a single or combination of vasoactive agents (e.g., PGE1, phentolamine, and papaverine) is administered [1–3].…”

“… The following parameters commonly used in vascular diagnostics for the blood‐flow quantification are useful in ED evaluation [5–16]: …”

“…Although recent studies claim a good predictive value of PSV measurement in this flaccid state, the universal consensus is to perform the study under pharmacologically induced erection [10][11][12][13][14][15]. For this, an ICI of a single or combination of vasoactive agents (e.g., PGE1, phentolamine, and papaverine) is administered [1][2][3].…”

Reply

“…In fact, studies have shown that the combination of injection and genital stimulation caused a significantly greater erectile response than re‐dosing [3]. While the use of audio‐visual stimulation might aid in erection [4], it is not a standard of practice in conjunction with penile CDU. In our study, the peak‐systolic velocity and end‐diastolic velocity values are mean values of right and left arterial measurements, and there was no statistical significance difference in the right vs left arterial parameters.…”