ICI should be given and re-dosed as necessary to achieve an erection rigidity of >80 %. This is very important because the degree of curvature is directly related to rigidity. We use Trimix (papaverine 30 mg, phentolamine 10 mg, prostaglandin E1 10 μg/mL) with a standard dosing regimen of 5, 10, and 10 units to achieve maximal rigidity. If the patient is already using ICI at home, we use their home dose for each of the three doses to achieve rigidity. In patients with concern for venous leak, we will use higher doses to try to achieve rigidity. Basal compression should be utilized to maximize penile rigidity. However, basal compression should not be used instead of an added penile injection when indicated. Beware using basal compression with basal deformity as the compression may distort the penis enough to make accurate assessment of the deformity difficult.

Using a goniometer , one should measure each curve separately (Figs. 7.2, 7.3, 7.4, and 7.5) starting with the most prominent curve. Make sure to document all curves, locations, and degrees. The distance of the point of maximal curvature from the coronal sulcus should also be documented (Figs. 7.6 and 7.7). If there is hourglass, tapering, or indentation, the location of these should be notated in reference to the coronal sulcus (Figs. 7.8, 7.9, 7.10, and 7.11). Quantifying curvature is relatively easy using a goniometer , but other deformities are difficult and we rely on mild, moderate, and severe for indentations and hourglass deformity. The penis should also be checked for stability, which may be done by applying axial loading pressure to the tip of the penis to identify if the penis buckles from the pressure. We rate level of instability: none, mild, moderate, and severe. This is highly arbitrary as instability assessment is a challenge, and if deformity assessment is not being routinely done in a practice, it is quite difficult to quantify.