Role of radioisotope penile plethysmography in the evaluation of penile hemodynamics in impotent patients

Validation of a continuous penile blood-flow measurement by pulse-volume-plethysmography

Today, in the assessment of cavernous artery blood-flow, the most commonly used technique is Doppler ultrasound velocimetry (continuous, pulsed, color-coded or power), which is often considered as the gold standard. Plethysmographic techniques and radioactive tracers have been widely used for the assessment of global penis flow variations but are not adequate for continuous blood-flow measurement. A new pulse-volume plethysmographic (PVP) device using a water-filled penile cuff was employed to assess continuous blood-flow measurement in the penis. Simultaneously Doppler velocity was recorded and served as a gold standard. A penile water-cuff is connected through a pressure tube to a three-way tap. The pulse-volume changes in the penile water-cuff are measured by means of a latex membrane placed over one of the three-way taps. The displacements of the latex are recorded by a photoplethysmograph. The third tap is connected to a 5 l perfusion bag placed 30 cm above the penis so as to maintain constant pressure in the whole device whatever the penis volume. Twenty-four volunteers were tested. The Doppler velocity signal and pulse volume of cavernous arteries were measured simultaneously after PGE1 intra-cavernous injection. Blood-flow variations were induced by increasing penis artery compression with a second penile water-cuff used as a tourniquet fitted onto the penis root, and the pressure of which could be modified by a water-filled syringe. The amplitude of the plethysmographic pulse-volume signal and the area under the Doppler velocity signal were correlated. The inter-patient (n=24) correlation ranged from 0.455 to 0.904, with a mean correlation of 0.704 and P<0.0001. PVP measurement by a water-filled cuff was validated by ultrasound velocimetry. This new continuous, non-invasive and easy-to-use technique enables physiological and physiopathological flow-measurement during sleep, under visual sexual stimulation (VSS), or following artificial erection. Simultaneous recording of penile blood-flow by PVP and intra-cavernous pressure (ICP) measured by a non-invasive device will provide fundamental inflow and outflow information in both physiological and pathophysiological conditions, and further enable venous leakage to be assessed by a mathematical model.