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Clinical evaluation of impotence.

With better understanding of the pathophysiology of erectile dysfunction, various causes of impotence can be identified accurately with the help of different investigation modalities. However, it is controversial as to what extent investigations are considered as adequate because most of the time they do not influence patient management. The clinical evaluation of erectile dysfunction should include a thorough sexual and medical history and physical examination. Further special investigations such as nocturnal penile tumescence studies, duplex ultrasonography, dynamic infusion cavernosometry and cavernosography, and arteriography should only be ordered logically after careful consideration of whether they will affect patient outcome. Therefore in this review, we aim to evaluate critically these different special investigations with regards to their indications and pitfalls so that a logical approach to the evaluation of impotence can be obtained.