Objectives. To objectively evaluate the contents of corpus cavernous tissue in impotent men using an automated novel image analysis system. Methods. Thirty-three impotent men and 2 normal potent men (controls) underwent corpus cavernous biopsies. The procedures were performed using a Biopty gun under local anesthesia. The obtained specimens were stained with Masson's trichome technique, and the collagen fiber contents were evaluated by a computerized morphometric analysis method. In addition, we estimated the intraobserver and interobserver reliability of this automated image analysis system. Results. No major complication was noted during or after the biopsies. Of the 33 impotent patients, 3 were diagnosed as having psychogenic, 11 as having arteriogenic, 13 as having venogenic, 1 as having neurogenic, and 5 as having idiopathic impotence. The collagen fiber percentages in the 35 men were as follows: normal potent: 48.2% ± 1.4%, psychogenic 55.2% ± 11.6%, arteriogenic 73.2% ± 4.4%, venogenic 66.5% ± 4.2%, neurogenic 76.9%, and idiopathic 77.4% ± 4.2%. Significant differences were found between the normal potent and arteriogenic groups (P < 0.05) and between the normal potent and idiopathic groups (P < 0.05). Patients older than 60 years had a higher collagen fiber content (70.4% ± 3.7%) than those younger than 50 years old (58.6% ± 5.2%). The interobserver and intraobserver variances were both negligible for this automated image analysis system. This method significantly reduced the amount of variation introduced by the intra-rater reliability of a technician compared with the manual method. Conclusions. The present automated image analysis system is believed to be a reliable, accurate quantitative measurement tool for studies of penile tissue. Cavernous biopsy is a rapid, safe, and representative modality to study penile disease. An increase in cavernous collagen fibers (or corporal fibrosis) is considered an important factor in impaired erectile function. (C) 2000, Elsevier Science Inc.
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