1. Physiological testing for E.D
Dr. Amir H Kashi

2. The best evidence could be visual inspection of erect penis:
Patient
Doctor
Subjective and not practical

3. Indications Not routine Indications:
Supposed to differentiate between psychological and organic causes of ED
Do they?

4. ISSM: Nocturnal penile tumescence

5. Typically, men have 3 to 5 erections during 8 hours of sleep.
These erections may last for thirty minutes or longer and occur during the rapid eye movement sleep cycle, during which most dreaming occurs.
Men usually have these erections throughout their lives.
While the exact reasons for these erections are not clear

6. Association of night erections With REM sleep in a case report
Nat Clin Pract Urol. 2005;2(5):

7. Lay term: Morning wood
Decreased release of noradrenalin and distension of bladder were supposed as proposed mechanisms not yet proved.

8. NPT: Standard sleep laboratory method:
Measure: Tumescence, rigidity duration AND maximal penile rigidity
With Electroencephalography, eletro- oculography, electromyography, and nasal air flow and oxygen saturation to document REM and hypoxia.
Sleep apnea/periodic limb movement/sleep disorders abnormal NPT

9. 2-3 night to overcome 1st night effect
Axial rigidity  awaken the patient on full rigidity and buckle a device on the tip of penis:
500 g minimal
1.5 kg full axial rigidity
2-3 night to overcome 1st night effect

10. Problem Time consuming and costly Development of Rigiscan ®:
Portable device
Computerized software to document time-interval of erections with radial rigidity and tumescence

12. Normal criteria: Not consistent in the literature: EAU(2017)
Clinical Uro-Andrology; Mirone.V(Ed); Springer, Italy 2015.
2 nights; tip rigidity> 60% for > 10 min
Campbells Urology:
4-5 events, duration> 30min, tumescence>3cm at base and >2 at tip, > 70% rigidity (base and tip)
Clinical Andrology; Bjorndahl L et al.; Informa, EAU 2010.
>70% rigidity per event (4-6 events in 8 hr sleep is normal)
Iran Urology Textbook:
4-5 events; >30 min; >70% normal, <40% abnormal

13. Pitfalls: There are false positive: False negative: Hypogonadal men
Sleep disorders; depression

14. Be careful in routinely using NPT: Indications maybe:
Differentiation of organic vs. psychogenic
Legal cases (3 nights)
Undetermined Etiology
Nonresponse to med.
Before invasive interventions

15. Evidence: International Consultation in Sexual Medicine report:
Level 2B evidence for:
Vascular studies
NPT by Rigiscan® and BCR reflex

16. Audiovisual and Vibratory Stimulation
Apart from sleep erections, they can naturally occur with awake man

17. Instead of sleep using
Visual or sensory stimulation
And determination of erection
Can be combined with med. Inj. And Rigiscan
Measured when awake more physiological

18. Again: Positive finding: endocrinopathies
Negative finding: psychologies like erotic excitement inhibition

19. BCR reflex latency