THE DIAGNOSIS OF IMPOTENCE Report 4. Criteria for Assessment of Nocturnal Penile Tumescence Seiji Akazawa Takamatu Red Cross Hospital, Kagawa, Japan T

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1 THE DIAGNOSIS OF IMPOTENCE Report 4. Criteria for Assessment of Nocturnal Penile Tumescence Seiji Akazawa Takamatu Red Cross Hospital, Kagawa, Japan The recorded data obtained through monitoring nocturnal penile tumescence (NPT) is an objective method for determining the erectile status of patients who complain of impotence. But, the validity of NPT as a means of distinguishing between functional and organic impotence has not been firmly established. Recently, many authors have assessed NPT on the basis of penile circumferense. Because of the periodic occurrence of NPT in association with rapid eye movement sleep, periodicity shold also be considered an important aspect of NPT. Therefore, we devised a classification standard for NPT on the basis of periodicity and degree of distention and compared the results with clinical appraisais and data obtained during treatment. The following results were obtained. 1. Five healthy adults who all displayed periodic, vigorous NPT were classified as MSIa. 2. Of 21 patients complaining impotence, 7 were classified as MSIa, 2 with periodicity but week NPT were classified as MSIb, 6 with no periodicity but strong NPT as MSIIa, 3 who displayed no periodic and week NPT as MSIIb, 1 with hardly any NPT as MSIII, and 2 without any observable NPT as MSIV. 3. When these results are compared with clinical findings, it is certain that MSIa represents functional, and MSIII and MSIV organic impotence. In the cases of MSIb and MSII, however, it can not be decided, on the basis of NPT alone, whether they represent functional or organic impotence. The recorded NPT data provides an excellent method for diagnosing potency, follow-up studies of a much larger sample are needed to adequately assess such data. The classification standard devised for this study may be thought of as a servic eable, objective way of expressing recorded NPT.

3 1417 Fig. 水銀strain Fig. 2 Ia MS Ib 水銀ストレイゲージブロックダイアグラム gauge 水銀ストレイゲージによるnoctumal tumescenceの MS 1 penile Fig. 記録(1) MS IIb MS III MS MS IIa 3 水銀ストレイゲージによるnoctumal tumescenceの IV 記録(2) penile

7 2) Karacan, I.: A simple and inexpensive transducer for quantitative measurements of penile erection during sleep. Behav. Res. Meth. Instru, 1, , ) Matsumoto, J., Nishisho, T., Suto, T., Sadahiro,

8 Medicine3(12), 28-35, ) Fisher, C., Gross, J. and Zuch, J.: Cycle of penile erection synchronous with dreaming (REM) sleep. Arch. gen. Psychiatry, 12, 29-45, ) Karacan, I., Goodenough, D. R., Shapiro, A. and Starker, S.: Erection cycle during sleep in relation to dream anxiety. Arch. Ge. Psychiat. 15, , ) Karacan, I.: Clinical value of nocturnal erection in the prognosis and diagnosis of impotence. Med. Aspects Hum. Sex, 4, 27-34, 1970, 15) Karacan, I., Scott, F. B., Salis, P. J., Attia, S. L., Ware, J. C., Altinel, A. and Williams, R. L.: Nocturnal erections, Diff erencial diagnosis of impotence, and Diabetes, Biological Psychiatry, 12, , ) Procci, W. R., Goldstein, D. A., Adelstein, J. and Massry, S. G.: Sexual dysfunction in the male patients with uremia. Kidney Intern., 19, , 1981, 17) Tulloch, A. G. S., Keogh, E. J., Csillag, E. R., Dunn, J. C., Brown, D. S. and Morlet, A.: Impotenc-The team approach to investigation and surgical treatment. Brit. J. Urol., 54, , ) Morales, A., Marshall, P. G., Surridge, D. H. and Fenemore, J.: Corporeal calibration: A discriminatory test for impotence. J. Urol., 128, 41-44, ) Fisher, C., Schiavi, R. C., Edwards, A., Davis, D. M., Reitman, M. and Fine, J.: Evaluation of nocturnal penile tumescence in the differential diagnosis of sexual impotence. Arch. Gen. Psychiatry, 36, , 1979, 21) Marshall, P., Surridge, D. and Delva, N.: The role of nocturnal penile tumescence in differentiating between organic and psychogenic impotence: The first stage of validation. Archives of Sexual Behavior, 10, 1-10, 1981.

Fig. 1 Clinical findings and extent of inflammation area in female urethrocystitis Fig. 2 Classification and distribution of female patients with blad

Key words: Female with bladder irritability, Subjective symptoms, Pyuria, Bacteriuria Fig. 1 Clinical findings and extent of inflammation area in female urethrocystitis Fig. 2 Classification and distribution