Diagnosis of ED: Electromyography

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Diagnosis of ED: In 1988, G. Wagner and T. C. Gerstenberg first described changes in the electrical activity of the cavernous tissue depending on the phases of erection. In 1990, W. F. Thon proposed the use of cavernous tissue electromyography to objectively assess the state of autonomous innervation and determine smooth muscle degeneration, cavernous or myogenic dysfunction.

The relationship between the indicators of the electrical activity of the cavernous bodies and the content of smooth muscle structures in the cavernous tissue, detected by histomorphometric analysis, was found.

J. Ponseti found that in most cases, the activity of the brain (according to the results of electroencephalography) directly correlated with the readings obtained by electromyography of the cavernous bodies. Thus, the electrical activity of the penis is controlled by the brain, and the autonomic signal reaches the cavernous bodies within fractions of a second after the start of sexual stimulation. This experimental paradigm can be used in the study of psychogenic ED, in order to develop an objective method for studying this condition.

According to F. Giuliano, performing electromyography allows us to determine abnormalities in the development of smooth muscle cells of the cavernous bodies, corresponding to damage to the autonomic innervation of the penis and degenerative processes in the cavernous bodies.

M. Virseda-Chamorro and his team studied the electrical activity of the cavernous bodies in patients with arteriogenic ED based on the results of penile vascular pharmacodopplerography. Ultrasound confirmation of insufficient erection, associated with a decrease in the activity of the electrical signal, according to the electromyography of the cavernous bodies, demonstrated 66.7% sensitivity and 92.9% specificity in the diagnosis of ED. Due to the high specificity of the electromyographic response to prostaglandin E1 injection, this test can be useful as a screening in the diagnosis of ED (arterial).

However, the results of penile electromyography can be questioned if we take into account the fact that the source of the signal when performing electromyography is not the cavernous bodies, but the skin of the penis or the surrounding tissues. In a study by L. S. Leddu et al. on healthy volunteers who did not suffer from ED, a drug block of the skin and cavernous nerves was performed. It turned out that the cavernous tissue is the source of the electrical signal. The authors also suggested that further improvement of this technique may make it useful in the differential diagnosis of neurogenic and myogenic ED.

According to M. Aldemir, electromyography should not be used as a method for determining age-related changes in cavernous bodies.

Currently, electromyography of the cavernous bodies is not among the main studies in the diagnosis of ED and is used in some cases: in post-traumatic ED (for example, as a result of blunt trauma to the perineum), after surgical interventions on the pelvic organs (radical prostatectomy) in patients with diabetes mellitus.

Diagnosis of ED: Cavernosography

The role of the venous system in the mechanism of developing and maintaining an erection has been the subject of discussion for many years. At the beginning of the XX century, J. S. Wooten demonstrated the importance of the venous system in the process of erection development and noted an improvement in the quality of the latter after ligation of the deep dorsal vein.

The technique of cavernosography is not new. It was first used by A. De la Pena in 1946 to visualize the veins of the pelvis. And in 1955, F. May and H. Hirtl described the normal X-ray image of the cavernous bodies, as well as the changes that occur in injuries, inflammation, tumors of the cavernous bodies, priapism. In 1980, J. Ebbehøj and P. Metz proposed the use of cavernosography, performed against the background of visual erotic stimulation, to determine the state of the venous system. In the modern sense, cavernosography was first proposed in 1984 by R. Virag and his co-authors. They performed an X-ray examination of the cavernous bodies after administration of a vasoactive drug (papaverine), which induced an erection and allowed visualization of the cavernous bodies in an erect state.

diagnosis of ED

Varicose veins, persistent contrast of the main venous collectors of the penis before and after administration of the vasoactive drug indicate a pathological venous discharge of one type or another. The question of the diagnostic significance of penile glans contrast is still a subject of discussion.

Since the 1980s, cavernosography, which was previously used in the demonstration of Peyronie’s disease, traumatic penile injury, and priapism, has taken an important place in the diagnosis of ED.

Conclusion

Today we did not write about the use of Viagra or the purchase of Viagra on the Internet, we provided an overview of the works published over the past decade. They confirm the fact that the main task of diagnosing ED is to establish its true cause. It is obvious that it is advisable to use research methods with proven effectiveness, since this will ensure an effective approach to treatment. Currently, methods for diagnosing ED need to be optimized. It is necessary to develop a personalized diagnostic algorithm aimed at assessing the state of the cardiovascular system, endothelium, androgen status, etc. to improve the effectiveness and safety of treatment for men suffering from various forms of ED.

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