An evidence-based perspective to commonly performed ED investigations
2012-01-01 00:00:00
Currently there is no universally accepted gold standard diagnostic test to differentiate psychogenic from physical erectile dysfunction (ED). Instead, sexual health specialists rely on a detailed history, a focused physical examination and specialized diagnostic tests to decide the etiology of the ED. We review the concepts of evidence-based medicine (EBM) in the area of medical diagnostic tests. We highlight four of the well-known diagnostic tests (penile duplex, pharmacoarteriography, pharmacocavernosometry/ cavernosography [PHCAS/PHCAG] and nocturnal penile tumescence [NPT]) monitoring for ED evaluation within an evidence-based perspective.
While penile color Doppler has good evidence of supporting its use in the diagnosis of arteriogenic ED, data supporting its diagnosis of a physical disorder associated with cavernous venous occlusion dysfunction are lacking. PHCAS/PHCAG’s main drawback is an unknown positive predictive value and a possibility of frequent false positive results. NPT has many advantages when differentiating psychogenic from organic ED, however, several questions related to its physiological mechanisms do exist.
Several good diagnostic tests are useful in the evaluation of men with ED. However, modern evidence based concepts – mainly the Positive Predictive value and Likelihood Ratio – need to be assessed and applied to these tests to obtain their maximum clinical benefits.
References: 1. An Evidence-Based Perspective to Commonly Performed Erectile Dysfunction Investigations. Hussein Ghanem & Rany Shamloul. J Sex Med Volume 5, Issue 7, July 2008, Pages: 1582-1589 2. Broderick GA. Evidence based assessment of erectile dysfunction. Int J Impot Res 1998; 10 Suppl 2:S64-73.
Speakers: Dr Hussein Ghanem
Conference: WAS Goteberg 2009
Areas of Interest / Categories: Erectile Dysfunction, WAS 2009
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