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Combined Papaverine Test and Radionuclide Penile Blood Flow in Impotence: Method and Preliminary Results
Author(s) -
GRECH P.,
DAVE S.,
CUNNINGHAM D. A.,
WITHEROW R. O'N.
Publication year - 1992
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1992.tb15569.x
Subject(s) - papaverine , penis , medicine , blood flow , intracavernous injection , anesthesia , cuff , arterial insufficiency , hemodynamics , surgery , cardiology
Summary— The investigation of vascular impotence requires a simple, reliable and non‐invasive method of estimating penile arterial supply. A method for measuring flow to the dependent portion of the penis has been developed using technetium‐labelled red blood cells ( 99m Tc‐RBC). Its use, in conjunction with the intracavernous injection of papaverine, was investigated in 32 patients with various causes of impotence. Intracavernous papaverine was administered and a pneumatic cuff was inflated around the base of the penis both to isolate the penile circulation and to prevent dispersion of papaverine. The remaining blood pool was labelled with 99m Tc‐RBC. A gamma camera was used to produce a time‐activity curve for the penis following release of the cuff. Penile blood flow was calculated from the initial gradient of the time‐activity curve. Papaverine‐stimulated penile blood flow was significantly greater in patients without evidence of arterial insufficiency. None of the subjects with arterial disease achieved flows greater than 20 ml/min/100 ml, while flow in patients without arterial disease exceeded this value. Flow estimation without the use of papaverine was not able reliably to discriminate between the 2 groups. There was no difference in papaverine‐stimulated blood flow between impotent subjects with veno‐sinusoidal leakage, in the absence of arterial disease, and a control group who achieved full erection with papaverine. It was therefore possible, by assessing the response to papaverine and measuring arterial blood flow, to distinguish between arterial insufficiency, veno‐sinusoidal leakage and non‐vascular causes of impotence. The method requires little skill and can be modified for use with inexpensive equipment.