One of the first tests to confirm or rule out a vascular (blood vessel) cause of erectile dysfunction involves intracorporeal injections. This is a test performed in the office that requires an injection of the medicine used to treat ED (PGE 1 or a medicine similar) into the penis. PGE 1 has been described in earlier entries, similar to Caverject TM. If the patient cannot achieve an erection after proper dosing administration, he likely has vasculogenic (related to the blood vessels, or vasculature) erectile dysfunction.
For additional information, ultrasound can be used to visualize the arteries and veins before and after the injection. Ultrasound is what physicians use, for example, to visualize the growing fetus in a woman's uterus. It is a non-invasive (just placed on top of the skin) technique to see structures within the body. The ultrasound can detect the flow of blood and measure the velocity of that flow (how fast the blood is traveling). If the blood is traveling slower, the suspicion of a "blocked pipe," or clogged artery is assumed. This test cannot identify the exact area of blockage because the problem area usually is deeper in the body and closer to the major arteries in the pelvis.
An arteriogram is an invasive test that involves placing a needle in to the artery of the leg under x-ray guidance and injecting a radiographic dye into the artery to identify blockages. This test is rarely done, but will identify the exact area of blockage. A patient who would benefit from this type of testing is, let's say, a 24 year old who was the victim of a gunshot wound to the pelvis. Since the injury, he has been unable to obtain any erections. The suspicion of an injury to the artery may be rather high on the list. This patient, in the long run, may benefit from a vascular reconstructive procedure to restore the normal flow of blood. This is a surgery that re-routes the blood flow around the blocked blood vessels. This is a very specialized operation that uses either an already existing non-diseased artery or a non-diseased vein. Just like a plumber redirects the flow of water around the clogged pipe. This type of problem is rare, which is why this test is not commonly performed and most urologists would not include it in the discussion they have with patients on ED. Older patients may have blockages throughout their arteries from the deposition of plaques from high cholesterol. This is a different type of problem that does not benefit from surgery to improve the inflow to the penis.