Diagnostic Accuracy of Different Criteria of Pharmaco‐penile Duplex Sonography for Venous Erectile Dysfunction

Abstract

ObjectivesThe aim of this study was to analyze the diagnostic accuracy of different criteria of pharmaco‐penile duplex sonography in venous erectile dysfunction (ED).MethodsThe following parameters were measured after an intracavernous injection test in patients with ED from May 2016 to February 2017 at our hospital: diameter, peak systolic velocity, end‐diastolic velocity, and resistance index of the cavernous artery; diameter and peak velocity (if leak occurred) of the deep dorsal vein. Three ultrasonographic diagnostic criteria of venous ED were applied. Criterion A: continuous blood flow signals in the deep dorsal vein, peak velocity greater than 3 cm/s, peak systolic velocity greater than 30 cm/s, end‐diastolic velocity greater than 5 cm/s; Criterion B: resistance index less than 0.89 and other parameters corresponding with Criterion A; Criterion C: resistance index less than 0.80 and other parameters corresponding with Criterion A. The diagnostic results of each criterion were compared with the cavernosographic results.ResultsThirty‐six patients were diagnosed as venous ED by cavernosography in 54 ED cases. The diagnostic specificity, sensitivity, and accuracy of Criterion A were 70.6%, 91.7%, and 84.9%, respectively. Those of Criterion B were 82.4%, 69.4%, and 73.6%, while the results for Criterion C were 94.1%, 33.3%, and 52.8%, respectively. Criterion A had the highest diagnostic accuracy, the largest area under the receiver operating characteristic curve (area = 0.811), and the highest consistency (kappa = 0.642) with the cavernosographic results in the 3 criteria. The difference was statistically significant (P < .05).ConclusionsAmong the 3 commonly used ultrasonographic criteria, Criterion A is most appropriate in the diagnosis of venous ED.

The penile ultrasound study: an unnecessary exam or an ace in the hole?

“…There are however different ultrasonographic criteria to consider the presence of a venogenic ED. The detection of continuous blood flow signals in the deep dorsal vein, peak velocity greater than 3 cm/s, PSV greater than 30 cm/s, and EDV greater than 5 cm/s seem to be the criteria that best relate to cavernosography findings, with the highest sensitivity (91.7%) and the highest accuracy (84.9%) [7].…”

Time-effect of penile color duplex Doppler ultrasound for diagnosing vascular erectile dysfunction

“…Moreover, ED can be the first presenting symptom of multi-organ endothelial dysfunction. The pathophysiology of ED may be vasculogenic, neurogenic, anatomical, hormonal, drug-induced and/or factors may require further hemodynamic investigation, and in selected cases, this can be followed by an invasive penile angiographic evaluation [5]. Color duplex Doppler ultrasound (CDDU), first described by Lue et al [6], is an objective and reliable diagnostic method for documenting penile hemodynamics.…”

“…Color duplex Doppler ultrasound (CDDU), first described by Lue et al [6], is an objective and reliable diagnostic method for documenting penile hemodynamics. CDDU of the penis can also help differentiate psychogenic from organic ED [5]. Veno-occlusive mechanisms and arterial insufficiency can be assessed using peak systolic velocity (PSV), enddiastolic volume (EDV) and spectral patterns on pulsed wave Doppler ultrasound examinations [7].…”

“…The lack of standardized measures often prevents the accurate clinical diagnosis of patients undergoing hemodynamic assessment of the penis using CDDU [5]. This also leads to variability in data interpretation when comparing the results among various centers.…”

“…This also leads to variability in data interpretation when comparing the results among various centers. Sikka et al established standard operating procedures in 2012 and recorded data for arterial PSVs, EDVs, and resistance indices of the corpus cavernosum within 30 min after intracavernous injection (ICI) with prostaglandin E1 (PGE1) [5]. However, it is not clear which interval was the most suitable for diagnosis.…”