The diagnostic use of ultrasound and intracavernosal papaverine injections are widely used for diagnosis of vasculogenic impotence. Angiography is reserved for revascularization candidates. Other tests for penile vascular competence have not been clinically validated. Evoked-potential testing and biothesiometry are accepted techniques in impotence assessments. Excepting external vacuum devices, surgical implants, intracavernosal injections, and specific endocrine therapy, there is little evidence of benefit from other treatments of impotence.
Vascular surgery has only limited benefit in correcting penile abnormalities.
Intracavernosal injections has had demonstrated effectiveness, however concerns over long-tern morbidity persist. Extensive clinical experience with external vacuum devices demonstrate effectiveness in most patients. Hormonal therapy represents a specific treatment for a known endocrine abnormality. Prosthetic implants continue to be an option for patients failing other treatments. Technology Assessment report abstract.