Nocturnal penile tumescence and rigidity (NPTR, or, more simply, NPT) studies, with
or without the help of a recording computer (Rigiscan), have been traditionally positioned
at the head of several erectile dysfunction (ED) diagnostic flowcharts with the aim
to distinguish between psychogenic and organic etiology. Shall we continue to consider
these tools as a diagnostic gold standard in ED diagnosis?
Four scientists with expertise and/or interest in the area of ED pathophysiology and
diagnosis were asked to contribute their opinions.
To give to The Journal of Sexual Medicine's reader new stimuli to reexamine a still
largely utilized tool utilized in sexual medicine's clinical practice.
Of the four experts discussing the topic, the first who is the section editor of the
Controversy section, believes that NPT/Rigiscan cannot be considered a useful diagnostic
tool for differential diagnosis in ED. He is supported by the physiological considerations
of the second expert and by the experimental evidence produced and discussed by the
expert number four who questions the accuracy, reliability, and usefulness of these
tools to measure a critical aspect of the erection physiology which is the adequate
rigidity. In contrast, with several good arguments, the third expert still suggests
the use of these tools, perhaps not for every man presenting with ED, but at least
for the patient with no neurovascular risk factors who presents with a history suggestive
of a psychogenic cause.
The reader will judge if the expensive, complicated, and time-consuming effort to
record nocturnal erectile activity is or is not useful anymore for the patient and
for orienting the treatment choices.