Correlation of duplex sonography with arteriography in patients with erectile dysfunction.

Abstract

Our objective was to assess the accuracy of using measurements of peak systolic velocity in the cavernosal artery for the diagnosis of arteriogenic impotence. Twenty consecutive men with erectile dysfunction had duplex sonography after intracavernosal injection of papaverine to induce an erection. Peak systolic velocities in the right and left cavernosal arteries were measured by using Doppler sonography. Right and left selective penile arteriography was performed with low-osmolality contrast media after intracavernosal injection of papverine and intraarterial tolazoline. On the basis of the angiographic findings, penile arterial function was classified as normal, moderately insufficient, or severely insufficient. Doppler measurements of peak systolic velocity were correlated with arteriographic results. All 11 cavernosal arteries with peak velocities less than 25 cm/sec were associated with arterial disease, nine severe and two moderate. Thirteen of 17 carvernosal arteries with peak systolic velocities 25-34 cm/sec were associated with arterial disease, five severe and eight moderate. Only one of the 12 cavernosal arteries with peak velocity at or greater than 35 cm/sec was associated with arterial disease. We conclude that peak systolic velocity in the cavernosal artery as measured on duplex sonography is an accurate predictor of arterial disease in patients with erectile dysfunction. A peak systolic velocity of at least 35 cm/sec indicates normal arterial supply. At peak systolic velocities less than 35 cm/sec, the likelihood and severity of arterial disease increase as the peak systolic velocity decreases, with a peak velocity less than 25 cm/sec indicating a high likelihood of severe arterial disease.