Diagnosis of venous leakage by 133Xe corporeal clearance after intracavernous injection of prostaglandin E1 in poorly responding patients

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Abstract
133Xe corporeal clearance after intracavernous (IC) prostaglandin E2 (PGE-1) injection was assessed in detecting venous leakage (VL) in a group of impotent patients with poor clinical response to PGE-1 injection. 133Xe corporeal washouts were done in the flaccid state and at full erection or at 20 min after the IC injection of 20 $mug PGE-1 in cases where no full erection occurred in sequence on two separate days. In each case, data were acquired in frame mode after intracorporeal injection on one side of the midline just behind the glans of 0.1 ml, namely, 1–2 mCi (34–74 MBq) 133Xe in saline for 20 min. A time-activity curve was generated from the region of interest (ROI) at the site of injection and a computer routine was used to calculate clearance half-time (T1/2) in min and flow rate (Q) in ml per 100 g tissue per min. The data of 20 patients with equivocal response to IC PGE-1 were analysed. Of them, 14 had venous leakage and six had no vascular impairment (NVI). Venous leakage was proved by Doppler analysis, cavernosography after PGE-1, and/or selective arteriography. Twelve of 14 patients with VL had enhanced 133Xe corporeal clearance after PGE-1 with a significant decrease in T1/2 (mean ± S.D.) from 115.9 ± 196.0 to 13.3 ± 13.4 (P <0.05) and increase in Q from 2.1 ± 2.2 to 7.5 ± 5.6 (P <0.01). In contrast, all six patients with NVI had decreased 133Xe corporeal clearance. The sensitivity and specificity were 0.86 (12/14) and 1 (6/6), respectively, after PGE-1, and 0.79 (11/14) and 0.83 (5/6), respectively, in the flaccid state at a cut-off value of T1/2 of 20.9 min. In combination, the overall sensitivity increased to 1 (14/ 14). It is concluded that 133Xe corporeal clearance after IC PGE-1 injection is a useful and sensitive technique for detecting VL in erectile impotence with suboptimal clinical response to PGE-1 injection.

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