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A number of specialized investigations exist for the evaluation of erectile dysfunction but need not be part of the routine evaluation. The penile brachial index involves measuring penile pressure and comparing it with arm pressure. It has limited clinical utility because the data are based on superficial and deep penile arterial pressure, whereas erectile function depends on the deep arteries exclusively. Duplex ultrasonography allows for refined assessment of the penile circulation. The information it provides, however, is operator dependent and rarely alters patient management. Selective pudendal arteriography combined with intracavernous injection of a vasoactive drug should be limited to the small group of patients who are candidates for penile revascularization surgery. These patients include nonsmoking men less than 40 years old with a history of pelvic trauma who have sustained a penile arterial disruption.30 buy Viagra 200mg here canadian viagra for sale online Diabetes mellitus Known diabetes; polyuria; polydipsia;polyphagia Peripheral neuropathy; retinopathy; abnormal body mass index Abnormal fasting blood glucose Adult 25-100 mg PO 1 h before sexual activity; best absorbed when taken on empty stomach

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