Comparison of Penile:Brachial Index and Pelvic Angiogram

Abstract

After an initial evaluation indicating potential vasogenic impotence, 27 pa tients were identified as having had both penile:brachial index (PBI) and pelvic angiography done. All patients had also undergone psychiatric and hormonal evaluation, as well as nocturnal penile tumescence monitoring. If the PBI was consistent with vasogenic impotence (≤ 0. 7), an angiogram was performed. Twenty-one patients were found by angiogram to have impaired arterial inflow on at least one side, yielding a prevalence of 84%. Angiogram findings, in rela tion to PBI for each side, demonstrated that 30/49 (61%) sides had impaired inflow. Of the 24 patients for whom bilateral data were available, 9 (38%) had impaired inflow to both sides, while 12 (50%) had impaired inflow on only one side. Of these 21 patients who had impaired inflow, 16 (76%) had lesions of the internal pudendal artery or more proximally. Of the 30 sides with impaired inflow, 24 (80%) had lesions proximal to the internal pudendal artery, 1 (3%) had a lesion of the common penile artery, and 11 (37%) had lesions of the penile arteries either dorsal or deep.

Vascular disease may be missed by the PBI by singling out arteries other than the deep artery of the penis. The PBI has an important role in assignment of patients to angiography; at the 0.6 threshold, especially, PBI is shown to be a specific tool with a high positive predictive value in this patient population. The significant number of arterial lesions demonstrated in these patients lends sup port to a broader role for angiography in evaluation of men with impotence.