Nocturnal Penile Tumescence (NPT) Testing in Visual Studio .NET

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Nocturnal Penile Tumescence (NPT) Testing
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This method is useful for select individuals NPT testing takes advantage of the fact that men with normal erectile function have 4 6 episodes of involuntary, nocturnal erections lasting 20 50 minutes during a 6 8 hour sleep cycle These erections occur mostly during REM (rapid eye movement) sleep NPT testing in the diagnosis of ED has been described and is known worldwide [50] NPT is best used to distinguish between organic and psychogenic ED Other simple and inexpensive methods such as the stamp test [51], the snap gauge band [52], and the erectiometer [53], were developed originally to record nocturnal erections The common drawback of all these methods was that they could only record one nocturnal event Thus no information could be obtained on the duration and frequency of nocturnal
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6 SPACE could be useful in the diagnosis of autonomic neuropathy of the cavernous and/or myopathy of the cavernous muscles [56] Based on the results obtained in 214 patients with ED, and 39 normally-potent patients, they observed that 52% of all impotent patients had pathologic results in SPACE Further re nement of this method showed that surface electrodes as well as conventional concentric needle electrodes could be used to measure the electrical activity of the cavernous nerves With respect to the present status of CCEMG, it may be concluded that this method can detect abnormalities in cavernous muscle to a certain extent, although these pathologic alterations can be attributed to both damage to autonomic penile innervation and to degenerative processes of the cavernous smooth muscle There are indications that CCEMG amplitudes correlate with the density of the cavernous smooth muscle To date, there are no generally accepted standard criteria that would enable exact differentiation between normal and pathologic, and etiologic classi cation of the various ED forms is not possible Thus, despite the fact that CCEMG has been around for 10 20 years, it is still considered experimental It is far from becoming a routine procedure in the evaluation of ED etiology, especially in terms of autonomic neuropathy
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erections, and the degree of erection could not be suf ciently quanti ed The introduction of a computerized system called Rigiscan made it possible to measure both tumescence and rigidity during an 8-h sleep cycle Interpretation of Rigiscan results has been simpli ed by new, more extensive software (Rigiscan plus), which includes four new parameters In the Rigiscan , which is the most commonly-used device to measure NPT worldwide, two loops at the penile base and tip (coronary sulcus) are contracted every 20 sec to constantly record and store circumference and rigidity changes, ie the erection status A personal computer can then be used to print out the data [54]
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Corpus Cavernosum Electromyography (CCEMG)
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This procedure is used in the measurement of the re ex latency time of the BCR and pudendal, somatosensory-evoked potentials This method has a considerable shortcoming in that it only checks the integrity of the somatic penile nervous system and does not allow any statement in terms of autonomic penile innervation, the system that is mainly responsible for the induction of erection (parasympathetic nervous system) and detumescence (sympathetic nervous system) The greatest obstacle to evaluation of autonomic penile innervation, and in particular of the parasympathetic nervous system, is the fact that the cavernous muscle is the target organ of autonomic innervation of the penis, and that this is smooth muscle No standard clinical procedure has been established to date to measure the electrical activity of smooth muscle, unlike the case for striated muscle, which has been measured by a standard procedure for decades More than ten years ago, the research efforts of Wagner and Gerstenberg led to the rst published results for measuring the electrical activity of the cavernous muscle [55] The Hanover team led by Stief et al took up this method and re ned it under the term single potential analysis of cavernous electrical activity (SPACE) In their rst publication on this topic, they came to the conclusion that
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Sympathetic Skin Response (SSR)
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Measurement of heart beat variation and the sympathetic skin response are generally accepted and now standardized investigation methods to demonstrate involvement of the autonomic nervous system, eg in diabetes, although the SSR method evaluates the sympathetic nervous system SSR is infrequently used in the diagnostic evaluation of male ED, or in planning treatment for male ED The method makes use of a somatic afferent/ sympathetic re ex, via which the activation of sweat gland secretion in certain skin domains is transmitted, which in turn is accompanied by a change in electrical potential The method can in principle be used on different skin domains, although the palms and the soles are the most common domains Various authors have described SSR measurement
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Diagnosis of Erectile Dysfunction on the penis [57] Penile sympathetic skin responses could be provoked in 85% of normal individuals with latency times of 1100 1600 msec [58] Daffertshofer et al showed that the SSR can be the only neurophysiologic test with a pathologic result in some patients, although other neurophysiologic tests were normal [57]
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Summary
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While many tests are available for the diagnosis of male ED, the history, physical and partner discussions have surmounted the minimally invasive or more rigorous testing schema used for the evaluation of male ED in the 1980s and early 1990s This evolution was predicated on the introduction of oral therapies for male ED (PDE-5i), which supplanted and obviated the need for these tests
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