madman
Super Moderator
Ultrasonography after pharmacological stimulation of erection for the diagnosis and therapeutic follow-up of erectile dysfunction due to cavernovenous leakage
Summary
The goal of this work was to demonstrate that Doppler ultrasound (DUS) after pharmacological stimulation of erection (PSE) can be used to evaluate the presence and intensity of a cavernovenous leak (CVL) suspected in erectile dysfunction (ED) patients. The study was built around 50 DUS-PSE exams of penile arteries and veins, which were carried out 3, 5, 10 and 20 minutes after pharmacological stimulation. Measured parameters were end diastolic velocity of the cavernous arteries and mean velocity of the deep penile vein and/or penile superficial veins. A score from 0 to 3 was attributed to each according to the recorded velocities. A final score from 0 to 9 was established by adding the three values: patients quoting 0 and 1 were classified as ‘‘no leak’’ (n = 8); from 2 to 9 (n = 42) as ‘‘leaking’’. Penile computed tomography (CT-scan) under identical pharmacological stimulation identified the cavernovenous leak to be compared with the DUS-PSE results, which were valid in 47 cases (94%), with 97.6% sensitivity and 77.7% specificity. The kappa correlation coefficient for CT-scan diagnosis of suspected CVL was 0.7875 (P < 0.001). In addition, we found that end diastolic velocity in the cavernous artery, considered up until now as the gold standard in cases of suspected CVL was insufficient (negative predictive value = 47%). In addition to its well-known diagnostic value regarding ED of arterial origin, DUS-PSE is an excellent screening test for CVL, especially in young patients without vascular risk factors who are resistant to medical treatments. For those with well established CVL, confirmation by CT-scan to discuss possible surgery should be the next step. Moreover, DUS-PSE is useful in postoperative monitoring.
Conclusion
We have demonstrated that Doppler ultrasound with pharmacological stimulation of erection represents an excellent CVL screening test in the setting of erectile dysfunction evaluation, particularly in young patients without cardiovascular risk factor and who are disinclined to undergo drug-based treatment. When performed under technically adequate conditions, the procedure can eliminate insufficient erection maintenance in patients without venous leakage while referring those with leakage to a CT-scan unit and, in some cases, an operation. Doppler ultrasound also has a role to assume in postoperative monitoring insofar as it can confirm or rule out leakage persistence. That said, even though the test manifests sensitivity of 97.6% and specificity of 77.7% (statistically significant given the number of cases), the limitation of our study resides in the lack of assessment of males without erectile dysfunction, a type of evaluation that would have raised issues from an ethical standpoint. The DUS-PSE procedure proposed in this paper may nevertheless be considered as the reliable and indispensable examination aimed at ruling out or confirming CVL.
Summary
The goal of this work was to demonstrate that Doppler ultrasound (DUS) after pharmacological stimulation of erection (PSE) can be used to evaluate the presence and intensity of a cavernovenous leak (CVL) suspected in erectile dysfunction (ED) patients. The study was built around 50 DUS-PSE exams of penile arteries and veins, which were carried out 3, 5, 10 and 20 minutes after pharmacological stimulation. Measured parameters were end diastolic velocity of the cavernous arteries and mean velocity of the deep penile vein and/or penile superficial veins. A score from 0 to 3 was attributed to each according to the recorded velocities. A final score from 0 to 9 was established by adding the three values: patients quoting 0 and 1 were classified as ‘‘no leak’’ (n = 8); from 2 to 9 (n = 42) as ‘‘leaking’’. Penile computed tomography (CT-scan) under identical pharmacological stimulation identified the cavernovenous leak to be compared with the DUS-PSE results, which were valid in 47 cases (94%), with 97.6% sensitivity and 77.7% specificity. The kappa correlation coefficient for CT-scan diagnosis of suspected CVL was 0.7875 (P < 0.001). In addition, we found that end diastolic velocity in the cavernous artery, considered up until now as the gold standard in cases of suspected CVL was insufficient (negative predictive value = 47%). In addition to its well-known diagnostic value regarding ED of arterial origin, DUS-PSE is an excellent screening test for CVL, especially in young patients without vascular risk factors who are resistant to medical treatments. For those with well established CVL, confirmation by CT-scan to discuss possible surgery should be the next step. Moreover, DUS-PSE is useful in postoperative monitoring.
Conclusion
We have demonstrated that Doppler ultrasound with pharmacological stimulation of erection represents an excellent CVL screening test in the setting of erectile dysfunction evaluation, particularly in young patients without cardiovascular risk factor and who are disinclined to undergo drug-based treatment. When performed under technically adequate conditions, the procedure can eliminate insufficient erection maintenance in patients without venous leakage while referring those with leakage to a CT-scan unit and, in some cases, an operation. Doppler ultrasound also has a role to assume in postoperative monitoring insofar as it can confirm or rule out leakage persistence. That said, even though the test manifests sensitivity of 97.6% and specificity of 77.7% (statistically significant given the number of cases), the limitation of our study resides in the lack of assessment of males without erectile dysfunction, a type of evaluation that would have raised issues from an ethical standpoint. The DUS-PSE procedure proposed in this paper may nevertheless be considered as the reliable and indispensable examination aimed at ruling out or confirming CVL.
Last edited:
