Phalloarteriography in the diagnosis of erectile impotence

Abstract An angiographic method has been developed for x‐ray visualization of the arteries supplying the cavernous bodies of the penis, namely, the internal iliac, internal pudendal, and penile artery and its branches (dorsal, deep, and bulbocavernous arteries). Under normal conditions the technique makes pulsations in both dorsal penile arteries palpable, and the flow rate of fluid into the cavernous bodies necessary to produce and maintain erection can be determined. The principle of the method involves artificial passive erection or semierection, during which we perform selective or semiselective arteriography of the bed supplied by the internal iliac artery, or retrograde arteriography by puncture of the dorsal artery of the penis . Thirty males complaining of more than 1 year of impotence (including 12 diabetics) were investigated, 29 by our standard technique and 1 by translumbar pelvic arteriography with retrograde arteriography of the dorsal penile artery. All patients showed severe stenosis or obliteration of the vessels supplying the cavernous bodies. There was agreement between absence of pulsation in the dorsal penile arteries and the angiographic findings. Flow rates necessary to produce erection varied from 45 to 160 ml/min, with a mean of 90 ml/min. For controls, angiographic studies were performed in 4 men with clearly psychogenic impotence, all of whom were found to have normal‐appearing arteries supplying the cavernous bodies . On the basis of these findings and previously reported histological investigations, we believe that most impotence is the symptomatic and functional result of arterial disease. The arteriographic technique described allows a precise anatomical diagnosis to be made, and can indicate surgical and microsurgical correction .