Presentation Authors: Sheng-Yung Tung, Yi-Kai Chang, Hong-Chiang Chang, Tzung-Dau Wang, Lee Wen-Jeng, Shih-Ping Liu, Ju-Ton Hsieh, Wei-Lun Huang*, Taipei, Taiwan
Introduction: Penile Doppler ultrasound is a frequently-utilized tool for diagnosing vasculogenic erectile dysfunction (ED). Current guideline from European Urology suggested a cut-off value of peak systolic velocity (PSV) > 30cm/s and resistance index (RI) > 0.8 to be considered normal. Our study aimed to re-evaluate the diagnostic value of penile Doppler, and to assess the utilization of CT and pelvic angiography in clinical practice.
Methods: A total of 846 consecutive patients received penile Doppler exam at our institute between September 2008 and August 2017. Among them, total 436 times percutaneous transluminal pelvic angiography and possible angioplasty (PTA) were performed by a single cardiologist. Patients who had already received pelvic angiography previously were excluded. 109 patients who received further pelvic angiography within six months after penile Doppler exam were evaluated.
Results: Among the 109 patient, the median age was 60 years old (range 19-78), median BMI 26.8 kg/m2 (range 17.4-43.4). When defining normal erectile function as IIEF >= 17 or EHS >=3, PSV >35 cm/s or RI > 0.9 were the best cut-off value. CTA and PTA arterial stenosis had a good correlation, but there was no good correlation between PSV, EDV under penile Doppler and CTA or PTA arterial stenosis. Arterial stenosis >35 % under CTA and > 15% under PTA were the best cut-off value for erection function development.
Conclusions: For patients with erectile dysfunction, a higher cut-off threshold for PSV (>35 cm/s) and RI (> 0.9) under penile Doppler might be needed for better diagnosis of vasculogenic ED. CT had good correlation with angiography and could be considered as a non-invasive exam prior to angiography exam. The timing for PTA intervention for vascular type ED may earlier than expected.