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Phosphodiestrase-5 inhibitors are an important line of treatment for erectile dysfunction ( ED). To detect the clinical and hemodynamic predictors of sildenafil response, we conducted this study on 124 Egyptian men with ED. All patients were evaluated by thorough history and clinical assessment with measurement of the abridged international index of erectile function-5 ( IIEF-5) score. All patients were then subjected to intracavernosal injection ( ICI) of trimix and pharmaco-penile duplex ultrasonography ( PPDU). Patients were then classified into sildenafil responders and non-responders after six consecutive doses of 100 mg sildenafil. On doing the binary logistic stepwise regression analysis, only ED duration, IIEF-5 score, and response to ICI were the significant independent predictors of sildenafil response. These three parameters together correctly predicted the sildenafil response by 81.5% ( p value <0.001). With the receiver operator characteristic curve analysis, the cut-off value of ED duration was 2.5 years and it was 14 for the IIEF-5 score. These findings indicate that ED duration, the IIEF-5 score and response to ICI are more significant predictors of sildenafil response than the more expensive and time-consuming PPDU testing. [ABSTRACT FROM AUTHOR]

Introduction: It is claimed that the tunica albuginea (TA) shares in the erectile mechanism by compressing the emissary veins passing through it. However, the TA does not contain smooth muscle fibers., Aim: We investigated the hypothesis that TA lacks a contractile activity on the emissary veins passing through it., Methods: Fourteen healthy male volunteers (mean age 35.2 +/- 4.3 years) were studied. The electromyographic (EMG) activity of the TA and corpora cavernosa (CC) was individually recorded in the flaccid and erectile phases by EMG needle electrodes. Recording was performed in the upper, middle, and lower third of the TA and CC on one and then on the contralateral side., Main Outcome Measures: The TA lacks a contractile activity on the emissary veins passing through it., Results: The EMG of the CC in the flaccid phase recorded regular slow waves and random action potentials. The wave variables in the erectile phase exhibited a significant decrease (P < 0.01) compared with the variables in the flaccid phase of the same subject. The TA EMG showed no electric waves in the flaccid or erectile phases. These recordings were similar from the upper-, middle-, and lower-third of the penis, and were reproducible from the contralateral CC., Conclusions: Electric waves were recorded from the CC in the flaccid phase; wave variables decreased at erection. In contrast, the TA showed no electric waves in the flaccid or erectile phases. It appears that the TA acts as a CC covering sheet which expands passively at erection, and shares in compressing the subtunical venular plexus between it and the tumescent CC.