Objective: To investigate the application value of RigiScan monitoring in assisting tadalafil medication.
Methods: This self-control study included 89 ED patients (IIEF-5 < 21) treated in our hospital from August 2019 to July 2020. The patients underwent audiovisual sexual stimulation (AVSS), nocturnal penile tumescence and rigidity (NPTR) test, scoring on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-Item Scale (GAD-7), blood routine test, blood biochemical analysis, and hormone secretion examination, which confirmed 21 cases of psychogenic, 28 cases of organic and 40 cases of mixed ED. We treated the patients with tadalafil at 5 mg/d for 30 days, followed by examination of their erectile function by IIEF-5 scoring and AVSS and comparison of their erectile function with the baseline. For some of the patients that responded poorly to tadalafil at 5 mg/d, we increased the dose to 20 mg and detected the efficacy by AVSS at 1 h after medication. For those with organic or mixed ED irreponsive to tadalafil at 20 mg, we performed screening for corpora cavernosal venous leakage (CCVL) by intracavernosal injectionof alprostadil and penile color Doppler duplex ultrasonography or used dynamic infusion cavernosometry and cavernosography (DICC) to confirm the diagnosis of CCVL.
Results: The effectiveness rates of 5 mg/d tadalafil on mild, moderate and severe ED were 85.4%, 53.1% and 43.8%, respectively, significantly higher on mild than on moderate and severe ED (P = 0.002), and its effectiveness rates on psychogenic, organic and mixed ED were 90.5%, 60.7% and 57.5%, respectively, remarkably higher on psychogenic than on organic and mixed ED (P = 0.026). For those with organic or mixed ED irresponsive to 5 mg/d tadalafil, the increased dose of 20 mg achieved an effectiveness rate of 64.3%. (P = 0.033). The results of DICC did not encourage tadalafil medication for the cases of organic or mixed ED with CCVL irresponsive to both 5 mg and 20 mg tadalafil.
Conclusion: RigiScan monitoring plays a guiding role in tadalafil medication of ED and helps distinguish organic from psychogenic ED. Tadalafil at 5 mg/d produces a better effect on mild than on moderate and severe ED, and so does it on psychogenic than on organic and mixed ED. The dose of medication can be increased to 20 mg for organic and mixed ED irresponsive to 5 mg tadalafil, but tadalafil is not recommended for organic and mixed ED with CCVL irresponsive to both 5 mg and 20 mg tadalafil.
Keywords: tadalafil; erectile dysfunction; RigiScan； treatment option.