Are Patient Reports the Best Tool to Diagnose Impotence?
WebMD News Archive
Treatments for many disorders can be very expensive, and if there are no useful objective tests, it may be difficult to convince insurance companies to pay for it based upon the subjective views of the patient.
Jan. 7, 2000 (Indianapolis) -- Treatments for many disorders can be very
expensive, and if there are no useful objective tests, it may be difficult to
convince insurance companies to pay for it based upon the subjective views of
the patient. An article in the January edition of The Journal of Urology
suggests that standard tests for erectile dysfunction (ED) are not helpful in
diagnosis, and this may impact on the reimbursement of treatment expenses.
"In our experience, evaluation of male sexual dysfunction has gained
other dimensions and moved from pharmacostimulated testing to a more complex
approach to male sexual health," writes lead author Kurt Lehmann, from the
urologic division of the Kantonsspital Baden in Switzerland. "Soon we will
have to prove or disprove patient sexual dysfunction to support application for
treatment reimbursement. We need instruments that are reliable, minimally
invasive, and specific to discriminate patients from men who want to increase
The researchers evaluated 77 patients who sought treatment for ED.
Assessment included patient reported data on sexual erections (rigidity,
capability of vaginal penetration, duration), standard clinical and laboratory
tests, and other diagnostic tests such as intracavernous injection and
sonography. Data was compared on the basis of whether vaginal penetration was
possible, feasible only with manual assistance, or possible but not long enough
for satisfactory performance.
Of the 77 patients studied, 36 were unable to perform vaginal penetration,
28 needed manual help, and 13 had erections sufficient for penetration but were
not satisfied by their performance. In contrast, response to diagnostic tests
could not discriminate among the groups even though their self-reported
symptoms varied widely.
"In these days of cost containment and therapy oriented evaluation,
further tests that increase expenses are contraindicated unless they can prove
the presence and degree of ED," writes Lehmann. "Our study indicates
that pharmacostimulation tests do not fulfill these criteria. We urgently need
widely accepted instruments for evaluation of patients with ED because
reimbursement will be coupled with strict limitations."
Although he agrees with this article that there is no method of objectively
verifying ED, Ira Sharlip, MD, medical director of Pan Pacific Urology in San
Francisco, tells WebMD he thinks most of the reimbursement problems in the U.S.
are tied to the cost of treatment rather than the inability to objectively
establish the diagnosis.