Bulbocavernosus-reflex latencies and pudendal nerve SSEP compared to penile vascular testing in 669 patients with erectile failure and other sexual dysfunction.

The purpose of this current study was to find out the coincidence of pathological penile vascular supply with pathological data in Bulbocavernosusreflex latency (BCR-L) measurements and Pudendal Nerve SSEP (PudSSEP) recordings. Six hundred and sixty-nine males (642 with erectile dysfunction, 27 with different sexual disturbances) (mean age 49.3 y, range 17-76 y) underwent consecutively a battery of neurophysiological investigations together with pharmacotesting of cavernous bodies combined with duplex sonography of penile arteries. Pathological vascular findings were indicated in 286 men (43%), pathological neurophysiological findings in 264 men (39%). Normal findings in both investigations (vascular and neurophysiological) were encountered in 252 men (38%); 131 men (19%) revealed pathological data exclusively in the neurophysiological parameters, 153 (23%) exclusively in the vascular parameters and 133 (20%) in both. The highest percentages of pathological findings were observed in patients with diabetes mellitus (110 out of 131, 88%) and patients who had sustained pelvic trauma or surgery (36 out of 44, 82%), in contrast to the lowest percentage in patients with a proven psychogenic etiology (10 out of 38, 26%). Somewhat surprising was the rather high proportion of vascular impairment in patients with defined neurological diseases such as alcohol abuse (20 out of 51, 43%), polyneuropathy (PNP) of various etiology (9 out of 19, 47%), lumbosacral radiculopathies (26 out of 65, 40%), and CNS diseases (24 out of 52, 46%), about half of them coinciding with pathological neurophysiological findings. Even if the validity of BCR-L measurement and PudSSEP recordings in the assessment of neurogenic impotence was controversely discussed, we conclude that in a large number of impotent males both neurogenic and vascular factors are responsible for the onset of erectile dysfunction.