It is notoriously difficult to make a differential diagnosis objectively between organic and functional impotence.
The author devised testing procedures designed to offer a method of differential diagnosis of both types of impotence by observing changes in the blood circulation in the cavernous body of the penis by the aid of isotope (
131I-RISA).
A total of 24 patients with disturbances in erection were examined. Of them, ten had experienced tauma or undergone a surgical operation of some organ in the pelvic cavity. Twelve were presumed to be cases of mental impotence. The remaining two were regarded as cases of psychotic impotence. In addition, five normal adult males served as controls and were subjected to the same tests as the patients mentioned above.
In the examination, a renogram apparatus, which is in general use, was employed. Such a collimator as shown in Fig. 2 was often used to avoid the counting of gamma rays coming from any portion other than the penis to the largest possible extent. The isotope used was
131I-human serum albumin (RISA).
It was injected intravenously in a dose of 20-40μCi. The isotope was administered in the manner as men tioned above. Changes in the blood circulation of the penis were recorded as a curve (the author called the curve a radioisotope penogram). When this curve became flat, the patient was injected subcutaneously with 1ml of yohimbine preparation (Fujicapin) and held under observation for any change in this curve.
1. Findings on the penogram of the normal adult male.
The curve of the penogram recorded in the normal adult male could be classified roughly into two types. In one type, the curve which had become flat after the administration with
131I-RISA began to as cend several minutes after Fujicapin had been administered. In the other type, the curve began to ascend after the administration with Fujicapin. It continued to ascend for 15-20 minutes. After that, it showed further rises recurrently.
2. Findings on the penogram of the impotent patient.
There was no difference in the penogram between the subject affected with mental or psychotic impotence and the normal human adult. Both in the normal and impotent persons, the circulating blood increased in amount in the penis after administration with Fujicapin. On the other hand, no changes in amount of circulating blood were observed at all in patients suffering from organic impotence after administration with Fujicapin. These patients had some disturbance in the nervi erigentes or in the erectile tissue.
It is presumed that the method of testing developed in the present investigation may make it possible to determine whether or not the inferior erection center of the sacral region of the spinal cord and other por tions inferior to this center is free from any disturbance.
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