Differences in polysomnographic, nocturnal penile tumescence and penile doppler ultrasound findings in men with stuttering priapism and sleep-related painful erections

Men with Stuttering Priapism (SP) and sleep-related painful erections (SRPE) experience bothersome nocturnal painful erections resulting in poor sleep. The aim of this study is to observe common features and differences between men with SP and SRPE based on polysomnography, nocturnal penile tumescence (NPT), and penile doppler ultrasound (PDU). This is a prospective cohort study of 20 participants divided into two groups (Group 1 = SP [n = 12]; Group 2 = SRPE [n = 8]) with bothersome painful nocturnal erections. All participants were referred to the sleep disorder clinic to be assessed and consented for overnight polysomnography with simultaneous NPT recording and to complete validated sleep, sexual dysfunction and health-related quality of life questionnaires. Unstimulated PDU was also performed. Abnormal Polysomnographic findings (reduced sleep efficiency, total sleep time, and awake after sleep onset) were identified in both groups suggesting poor sleep. Men with SP had significantly longer erections (60.0 vs 18.5; p = 0.002) and took longer to detumesce once awake (25.7 vs 5.4 min; p = 0.001) than men with SRPE. They also had significantly higher peak systolic and end diastolic velocities on unstimulated PDU with an abnormal low resistance waveform identified. No sleep pathology was identified in men with SP. This implies a local (penile) etiology in men with SP. Men with SRPE had a normal resting PDU and abnormal sleep architecture with REM awakenings and significantly more Periodic limb movements (p = 0.04) than men with SP suggesting a central (sleep-related) cause in men with SRPE. Sexual dysfunction and poor HR-QoL was identified on validated questionnaires in both groups. SP and SRPE are rare entities that share similar symptoms (painful nocturnal erections and poor sleep) but dissimilar features of nocturnal erection onset, duration and resolution with different polysomnographic features which may allude to a different pathophysiology.

Percutaneous Cavernous Nerve Electro-Stimulation for Treatment of Erectile Dysfunction

Pelvic fracture urethral injury (PFUI) is the major etiological factor of neurological erectile dysfunction (NED). We reported a patient whose Index of Erectile Function-5 (IIEF-5) score was 7 (severe ED) and experienced a failed treatment of Tadalafil. NED was the final diagnosis made by examinations such as nocturnal penile tumescence (NPT), penile cavernous contrast and three-dimensional reconstruction and the penial dorsal nerve somatosensory evoked potential. Percutaneous cavernous nerve electro-stimulation was used as treatment for NED. After three courses of treatment, the IIEF-5 score was up to 18 points and the level of erection hardness was between grade III and IV. We concluded that percutaneous cavernous nerve electro-stimulation will be a new strategy to treat patients with NED with PFUI history.