Attitudinal changes to human sexuality and changing concepts on the etiology of erectile dysfunction from psychogenic to organic etiologies have increased the basic and clinical research in the field of male erectile dysfunction. As a result of this intensive research and with the introduction of vasoactive drugs for intracavernosal injection, a higher percentage of men, and especially older men, seek treatment for erectile dysfunction. Today the most effective and most popular treatment is intracavernous injection therapy. We are now searching for treatments that will be easier to administer and will fulfill at least part of the ''ideal medical treatment'' that should be effective, useful, free of toxicity, easy to administer and affordable. It is obvious that any successful medical treatment for erectile dysfunction requires a certain degree of integrity of the penile erectile mechanism. Therefore, any pharmacological treatment will be effective only in those patients in whom the physiologic components of the erectile process are either intact or only moderately affected by organic pathologic processes. It is our role as physicians to continue our basic and clinical research in the field of male sexual dysfunction. The availability of new medications or improvement in the administration routes of the currently used medications will attract more men to seek remedy for erectile dysfunction.

INTRODUCTION:Post radical prostatectomy potency rates, quantified on the basis of physician survey, have ranged up to 80%. Physician derived potency data, however, may not be representative of true post-prostatectomy potency rates or more importantly may not accurately portray patients' post-operative sexual satisfaction. We conducted a pilot study combining physician derived and patient derived subjective data with objective measures of erectile function.MATERIALS AND METHODS:Eleven men, mean age of 59 years, who were treated with nerve sparing radical retropubic prostatectomy formed the study group. Initially, the patients responded to a physician directed telephone survey on sexual status. Potency was then objectively assessed utilizing Rigiscan testing on two consecutive evenings. Lastly, the patients completed a validated short questionnaire directed to obtain a patients' subjective perception of sexual function.RESULTS:All the patients responded to the first part of the study by informing the physician that they were sexually active or potent after radical prostatectomy. Of these 11 patients, however, only 2 (18%) were mostly satisfied with their sex life according to the quality of life questionnaire. Rigiscan testing revealed that 8 of the 11 patients had nocturnal erections which were adequate for vaginal penetration. Of the 5 patients who stated that they were mostly dissatisfied with their sexual functioning, 3 had objective evidence of adequate erectile ability as documented by Rigiscan. Three of the four patients who were ambivalent with respect to their sexual function also demonstrated objective evidence of normal erectile activity.CONCLUSION:Although a patient may inform his care provider that he is sexually active or potent, he may not be satisfied with his present level of sexual functioning. In addition, we observed that some dissatisfied patients do have normal Rigiscan patterns indicating that a percentage of patients who are not happy with their level of sexual function after radical prostatectomy may have a psychogenic component to their problem.

Purpose: The computer generated recordings for 2 nights in 40 patients studied with the RigiScan dagger device were reevaluated using the new RigiScan Plus software to test its value in improving the discrimination between psychogenic and organic erectile dysfunction.Materials and Methods: Each man was evaluated for erectile dysfunction with a detailed medical and sexual history, physical examination, biothesiometry, plethysmography, 2 nights of ambulatory RigiScan monitoring and a psychological evaluation that usually included a private interview with the sexual partner. At the conclusion of evaluation each patient was broadly classified as having organic or psychogenic erectile dysfunction. The RigiScan reports were initially independently analyzed without the investigator's knowledge of the final diagnosis by determining the single best erectile event, with a minimal cutoff value of 60% erection for 5 minutes as necessary to be considered normal and the sum of measurements from the 2 nights. The original reading and final diagnosis were correlated. At this point the data were processed with the new RigiScan Plus software using 2 new measurements: 1) rigidity activity units and 2) tumescence activity units at the base and tip of the penis, and the results were correlated with the final diagnosis.Results: Evaluation of the single best event again showed that tip rigidity was the best single predictor if the diagnostic criteria were modified to 70% tip rigidity for 5 minutes with an estimate of correct classification of 92.5%. Nearly the same accuracy was obtained by base single event rigidity, tip rigidity and base tumescence activity units (each 90%). The summary analysis of all erectile events during the 2 nights of evaluation that had a low correlation with the final diagnosis using the original software showed that the best overall predictor of final diagnosis was tip tumescence activity units (92.5%), followed by base rigidity and tumescence activity units (each 90%).Conclusions: The RigiScan Plus software introduced 4 new parameters that facilitate interpretation of the RigiScan data. The new software did not improve the correlation with the final diagnosis compared to the subjective single best event analysis but added new objective parameters, measured and displayed by the software, that facilitate use of the data by the physician.

Penile revascularization surgery to correct penile vascular insufficiency has undergone several modifications since its introduction. Further improvement in the surgical success rate will be achieved with improved understanding of erectile physiology, diagnostic methodology, and both microsurgical and radiological techniques.

During the last two decades, significant advances have been made in the understanding of male sexual dysfunction. Concomitantly, a marked increase in both clinical and research activity in the field of male erectile dysfunction has led to a better evaluation and more treatment options. The prevalence and incidence are dependent on the definitions used, the diagnostic tolls, and the treatment options. Using standard definitions as suggested by the NIH Consensus Conference and improving our diagnostic and treatment options will have a major impact on the epidemiology of ED. A summary of the risk factors for ED is presented in Table 3. Still more epidemiologic research is essential to further understand the distribution as well as the prevalence of ED in certain ethnic groups, chronic conditions, and as a result of surgery and trauma. These studies will help us improve our diagnostic skills as well as our therapeutic options.

Until the early 1970s impotence was believed to be primarily a psychological disorder. The treatment usually consisted of empiric testosterone administration and psychotherapy, that were often ineffective. The introduction in the early 1970s of penile implants changed the treatment options and at the same time ushered in the modern era of male sexual medicine. Clinical as well as laboratory research improved significantly the diagnosis and treatment options of the impotent man. Today the man with a sexual problem has a much better chance of proper diagnosis and effective treatment.