What special tests do men need for impotence? What are the classification of erectile dysfunction

Impotence is a common male sexual dysfunction with complex etiology. Before diagnosis and treatment, complete medical history data of the patient should be obtained in detail, professional examination should be carried out, and then its sexual function should be accurately evaluated. Clinically, some patients should carry out some relevant auxiliary examinations or tests to help diagnose the cause. But not every patient with impotence must do every examination, otherwise it will not only bring mental pressure and pain to the patient, but also bring economic burden to the patient, so it should be carried out selectively.

What conditions does the diagnosis of impotence depend on?

1. Age "Simple Questions. The Ancient Theory of Innocence": "The husband's 28 kidneys are full of qi; the essence is easy to purge, yin and yang can have children... the liver is weak, the tendons are not active, the cassia is exhausted, the essence is little, and the kidney is weak" This is the normal physiological development process of men. After the "78", although not lift, but not sick. The author used compound Xuanju oral liquid to treat 335 cases of impotence due to kidney yang deficiency II. After clinical verification, the age distribution of compound Xuanju oral liquid in the treatment group was 76 cases (22.6%) aged 20-29 years, 100 cases (29.85%) aged 30-39 years, 88 cases (26.27%) aged 40-49 years, 49 cases (14.63%) aged 50-59 years.> There were 22 cases (6. 57%) aged 60 years old, of which the minimum age was 20 years old, the maximum age was 69 years old, and the proportion under 50 years old was large. A survey of 3389 normal men's sexual life in Japan found that there was a significant increase in the number of men aged 50 to 59 years old (516 cases) with a natural decrease in sexual life, and up to 21 people had no sexual intercourse. 1%, 0 for all age groups under 50. 7%~9。 1%, due to impotence, about 40 years old is a period of significant changes in male sexual life. The author believes that 20-60 years old is appropriate.

2. The success rate of sexual intercourse is not called "impotence". According to statistics, almost 50% of men who have had short or temporary sexual life "impotence" experience in sexual life belong to normal physiological category, just like people's appetite. For a while, it may be bad, so there is no need to worry. For more than 10000 adults, the concept of impotence is that the failure rate of penis erection is more than 75%, that is, the success rate of sexual intercourse is less than 25%, which can be called impotence. At present, it has been widely used in clinical research, diagnosis, treatment and efficacy standards at home and abroad. The impotence associations in Europe, the United States and Japan all follow this standard and have certain representativeness and strong operability.

In recent years, the concept of erectile dysfunction is different from that of erectile dysfunction. In recent years, there is a trend that impotence is collectively referred to as erectile dysfunction abroad. Erectile dysfunction is mainly divided into three types: prepenile type, penile type and penile abnormal erection. From this perspective, impotence is an erectile dysfunction. Erectile dysfunction includes impotence and Yangqiang. The author believes that from the perspective of TCM theory, the diagnosis and treatment of impotence is still more accurate.

Special examination of male erectile dysfunction

(1) Psychopsychological test: Many Minnesota Personality Inventory (MMpI) and Derogatis Sexual Function Questionnaire have reference value in the identification of qualitative erectile dysfunction, but cannot be used as an important basis.

⑵ Nighttime penile swelling test (NpT): In 1970, Karacan first used the physiological phenomenon of penile natural erection at night to identify psychological and organic fistula. This test is not affected by psychological factors and can more objectively reflect the penile erectile function. Normal people have erections 4 to 6 times a night, lasting 25 to 40 minutes. (rigidscan) The monitoring hardness is 65%~70%, but there are still 15%~20% false negative.

(3) Auditory visual stimulation test (ASS): monitor the changes of penis under the sexual stimulation of watching sexual behavior video. This is closer to the physiological state, to understand the penile erectile ability, but generally requires NpT comprehensive analysis and judgment for collaborative monitoring.

(4) Penile blood flow detection: Penile vascular disease is an important cause of organic erectile dysfunction, namely, arterial blood supply disorder and venous occlusion mechanism disorder.

Papaverine 30-60 mg, phentola 1-2 mg or prostaglandin E20 μ g. Used alone or in combination. When the drug is injected into the sponge, the penis can achieve a hard erection, lasting for more than 30 minutes, indicating that there is no obvious vascular disease, but there is still the possibility of false negative. The injection was supplemented with sexual stimulation, with high reliability. Complications such as ecchymosis, hematoma, abnormal erection of penis may occur.

Penile Doppler ultrasound monitoring: measure the ratio of penile artery blood pressure to brachial artery blood pressure (pBI). Less than 0. 6. It indicates that the blood supply of penis artery is impaired. The absolute difference between the two systolic pressures should not exceed 4kpa (30mmHg).

Penile blood flow index (pFI): The penis blood flow index was measured by the radial artery, the dorsal penis artery and the cavernous artery with Doppler ultrasound probe. PFI

Pulse volume recording of penile artery blood flow: the pulse volume waveform of normal penile blood flow rose rapidly to the peak, then decreased slowly, and there was a double-wave pulse cut mark. Round peak or slow decline, double wave pulse cut marks disappear, indicating vascular disease.

Color Doppler ultrasound detection: it is one of the most valuable non-destructive detection methods for screening vascular erectile dysfunction by detecting the cavernous structure, vessel diameter, blood flow velocity and vasodilation function, dynamic detection of penile artery, venous hemodynamic changes, cavernous resistance index, etc.

Cavernous perfusion test and cavernography: usually monitor the rate of induced erectile perfusion, maintain the minimum flow rate of erectile, and stop perfusion for 30 seconds, the pressure loss (pL) of cavernous body. The greater the value of MF and pL, the greater the function of venous leakage erectile dysfunction. Within 30 seconds, pL should be<3.3kpa (25mmHg), MF should be<20-40ml/min, and IF should be 80-120ml/min. Cavernography refers to injecting contrast agent to observe whether there is abnormal venous reflux during erection. Several common abnormal reflux include: the leakage from the deep dorsal vein of the penis to the prostatic plexus and vulva, the cavernous vein to the prostatic plexus and vulva, and the leakage between the cavernous body of the penis and the cavernous body of the urethra.

Internal pudendal arteriography: Before the reconstruction of the penile artery, the patients suspected of having blood supply disturbance of the penile artery should undergo bilateral internal pudendal arteriography through the femoral artery to observe the pathological changes of the dorsal penile artery and cavernous artery on both sides.

⑸ Erectile nerve detection: Nerve plays an important role in erectile mechanism, so routine detection and erectile related nervous system are crucial in etiological diagnosis, especially in patients with brain, spinal cord, pelvic trauma and diabetes history.

Latent time of bulbocavernous reflex: detect the dorsal penile nerve (sensory afferent) to the sacral cord, and then move to the conduction velocity of bulbocavernous muscle, ischiocavernous muscle and anal sphincter, which should normally be 27~42ms.