Pharmacoarteriography in the evaluation of impotence.

Progress in diagnosis and therapy of impotence is handicapped by the absence of a validated and objective method for evaluating the vascular system; a gold-standard for vasculogenic impotence is needed. Prior experience has indicated that conventional arteriography in unanesthetized patients is unreliable in evaluation of the penile arterial supply. We have improved our arteriographic methods by the routine application of selective pudendal injections, vasodilation pharmacoangiography with nitroglycerin and papaverine, and direct magnification. Experience in 37 impotent patients demonstrates marked improvement in the quality of visualization of distal vessels, and the frequent presence of functional vasoconstriction of medium and small arteries that can be distinguished from organic disease only with vasodilators. We believe these angiographic methods will improve the criteria against which other diagnostic and therapeutic methods can be objectively assessed.