DESCRIPTION
Dorsal nerve somatosensory evoked potential testing involves the electrical stimulation of the dorsal nerve of the penis and the recording of evoked potential waveforms over the sacral cord or cerebral cortex. The test attempts to evaluate peripheral and central afferent pudendal pathways and diagnose suprasacral lesions.
Sacral evoked potential testing attempts to measure peripheral neurologic integrity, including that of the dorsal and pudendal nerves. The procedure does not test central nerve integrity.
POLICY
Evoked potential measurements for the diagnosis of erectile dysfunction is considered not medically necessary.
ADDITIONAL INFORMATION
The clinical usefulness of penile evoked potential measurements is limited by the poor discriminatory value of response latencies. Most abnormal results can be predicted by the presence of diabetes or preexisting neurological dysfunction, or by evidence of neurological deficit discovered during the physical examination.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2002). Erectile Dysfunction (2.01.25). Retrieved November 7, 2007 from BlueWeb.
Broderick, G. A. (1998). Evidence based assessment of erectile dysfunction. International Journal of Impotence Research, 10 (2), S64-S73.
Delodovici, M. L., Fowler, C. J. (1995). Clinical value of the pudendal somatosensory evoked potential. Electroencephalography and Clinical Neurophysiology, 96 (6), 509-515. Abstract retrieved February 20, 2003 from PubMed database.
Klausner, A. P., Batra, A. K. (1996). Pudendal nerve somatosensory evoked potentials in patients with voiding and/or erectile dysfunction: correlating test results with clinical findings. The Journal of Urology, 156 (4), 1425-1427. Abstract retrieved August 10, 2001 from PubMed database.
National Institutes of Health. (1992, December). Impotence. NIH Consensus Statement. Retrieved August 6, 2001. Available at: http://consensus.nih.gov/1992/1992Impotence091html.htm
Nogueira, M. C., Herbaut, A. G, Wespes, E. (1990). Neurophysiological investigations of two hundred men with erectile dysfunction. Interest of bulbocavernosus reflex and pudendal evoked responses. European Urology, 18 (1), 37-41.
Pickard, R. S., Powell, P. H., Schofield, I. S. (1994). The clinical application of dorsal penile nerve cerebral-evoked response recording in the investigation of impotence. British Journal of Urology, 74 (2), 231-235. Abstract retrieved January 14, 2000 from PubMed database.
Salinas, C. J., Chamorro, M. V., Samblas, G. R., Esteban, F. M., Aristizabal, A. J. M., Delgado, M. J. A., et al. (1997). Analysis of pudendal nerve somatosensory evoked potentials in the diagnosis of neurogenic impotence. Archivos Espanoles de Urologia, 50 (5), 505-511. Abstract retrieved August 10, 2001 from PubMed database.
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EFFECTIVE DATE |
12/13/2007 |
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ID_BT
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