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The technique, involving use of a 27 30 g needle, is used to inject varying g (microgram) doses of PGE1 (Caverject ), or a triple drug mixture, approximately 5 15 min before the actual investigation The penile shaft is then draped with a sterile,

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Until the mid 1980s, penile angiography was regarded as the gold standard in the diagnosis of arteriogenic impotence This technique was mainly developed at the end of the 1970s by Ginesti and Romieu, whose standard work on this topic remains valid today [44] As a result of standardization of vascular diagnostic in erectile dysfunction, using non-invasive Doppler and duplex ultrasound, penile angiography is no longer a standard diagnostic test (45) The only remaining indications for penile angiography is in younger men under 50 years of age in whom an isolated vascular occlusion with the absence of further risk factors makes the option of penile revascularization appear logical Penile angiography is used for arterial embolization in cases of high- ow priapism [46]

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Choose Insert New Symbol to start a new symbol Create a black-filled oval with no stroke about the size of the largest ripple you want (which depends on your photo) Copy and paste it; then drag the copy off the original circle Change the fill to white Choose Modify Transform Scale and Rotate (Ctrl+Alt+S on Windows/ + Option+S on a Mac) Scale the oval to 90% and move it back over of the original oval, centering it Continue the same process, copying and pasting, dragging off the previous oval, scaling down, changing the color (alternately to black and

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electrodes located on the scalp at reference points CZ-2 and FpZ [47] The latency times of the pudendal, somatosensory evoked potentials depend on how tall the individual is The latency time until the rst positive amplitude P1 of SSEP is calculated according to the following formula [48] P1 latency (SSEP) = 541 + 0207 height of individual If the latency times of the BCR of the two control groups listed in Table 63 are compared to the results cited in the literature, mean BCR latency times > 40 42 msec must be generally considered as pathologic [48] Based on the normal values mentioned for BCR latency times and SSEP, Porst [49] showed that 65 (50%) of 130 patients with ED had pathologic BCR ndings Of 116 patients with ED, in whom SSEP was also measured, 31% (36) had pathologic ndings In total, 76 (66%) of 130 patients with ED showed abnormalities in neurophysiologic investigations [49] In the group investigated by Bemelmans, 58 (47%) of 123 impotent patients had pathologic ndings in the various neurophysiologic investigations [48]

(Continues)

41 6

Bulbocavernous Re ex Latency Times (BCR) and Somatosensory Evoked Potentials (SSEP)

JAMES AND JANE PERSON Notes to Financial Statements Note 1 The accompanying nancial statements include the assets and liabilities of James and Jane Person Assets are stated at their estimated current values and liabilities at their estimated current amounts Note 2 The estimated current values of marketable securities are either (a) their quoted closing prices or (b) for securities not traded on the nancial statement date, amounts that fall within the range of quoted bid and asked prices Marketable securities consist of the following: December 31, 20X3 Number of Shares or Bonds Estimated Current Values December 31, 20X2 Number of Shares or Bonds Estimated Current Values

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This method is used to prove the integrity of somatic penile innervation, which is transmitted via the pudendal nerve and its motor terminal branches to the pelvic oor muscles or their sensory branch the dorsal nerve of penis Measuring the re ex latency times of the BCR checks the peripheral re ex arch (S2 S4), and measuring central latency times (SSEP) checks central (spinal) nerve transmission A ring electrode on the distal shaft of the penis is used to apply rectangular impulses lasting 02 msec via a constant current stimulator, and the re ex latency time is measured via the needle electrodes placed in the bulbocavernous muscles Stimulus thresholds are chosen which permit constant re ex responses These are generally six to eight times the sensory stimulus threshold, which varies individually between 7 and 12 mA The interval between the stimuli is 40 60 sec, 10 consecutive responses being recorded The pudendal, somatosensory-evoked potentials and their latency times are also recorded via two

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