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Diagnosis and Treatment of Impotence

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Title: Diagnosis and Treatment of Impotence.

Agency: Agency for Health Care Policy and Research/Center for Health Care Technology (Formerly, the Office of Health Technology Assessment).

Contact: Harry Handelsman, D.O., Medical Officer; Thomas V. Holohan, M.D., Director, CHCT.

Status: Technology Assessment: Published, 1990.

Language: English.

Primary Objective: Scientific evaluation of current diagnostic and therapeutic interventions for the management of impotence for the Health Care Financing Administration's Medicare coverage policy.

Methods Used: Synthesis of published literature and information solicited from professional societies and organizations with interest or experience with these technologies.

Data Identification: English language journal articles and textbooks published between 1977 and 1988 available through the search capabilities of the National Library of Medicine. Key words: Impotence; diagnosis; treatment, Erectile dysfunction.

Study Selection: 170 citations of studies involving monitoring of nocturnal penile tumescence (NPT) penile vascular assessment, neurological assessment, endocrine assessment and various treatment modalities including revascularization, intracavernous injections, endocrine treatment, and external devices.

Data Extraction: Sensitivity and specificity of various diagnostic tests: Percentage of patients achieving resumption of sexual activity following therapeutic interventions.

Key Results/Findings: NPT has not been validated as a reliable test. Ultrasound evaluation of penile blood flow and intracavitary injection of papaverine are most commonly used to evaluate vasculogenic impotence. A definitive diagnosis of impotence related to venous abnormalities requires cavernosography and cavernosometry. Angiography is required prior to revascularyation: Evoked potential and biothesiometry are highly correlated with neurological disease.

Conclusions/Recommendations: NPT has little diagnostic value in home or laboratory setting. The diagnostic use of ultrasound and intracavernosal papaverine injections are widely used for diagnosis of vasculogenic impotence. Angiography is reserved for revascularization candidates. Other tests for penile vascular competence have not been clinically validated. Evoked-potential testing and biothesiometry are accepted techniques in impotence assessments. Excepting external vacuum devices, surgical implants, intracavernosal injections, and specific endocrine therapy, there is little evidence of benefit from other treatments of impotence. Vascular surgery has only limited benefit in correcting penile abnormalities. Intracavernosal injections has had demonstrated effectiveness, however concerns over long-tern morbidity persist. Extensive clinical experience with external vacuum devices demonstrate effectiveness in most patients. Hormonal therapy represents a specific treatment for a known endocrine abnormality. Prosthetic implants continue to be an option for patients failing other treatments.

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