Penile doppler ultrasound in patients with erectile dysfunction (ED): role of peak systolic velocity measured in the flaccid state in predicting arteriogenic ED and silent coronary artery disease.

INTRODUCTION The use of the penile peak systolic velocity (PSV) measured in the flaccid state during penile color Doppler ultrasound (PCDU) examination has been questioned without substantial evidence. AIM To assess the validity of PSV measured in the flaccid state during PCDU, in patients consulting for erectile dysfunction (ED). METHODS A consecutive series of 1,346 (mean age 55.0 +/- 12.0 years) male patients was studied. MAIN OUTCOMES MEASURES All patients underwent PCDU performed both in the flaccid state and dynamic (after prostaglandin E1 stimulation) conditions. A subset of 20 subjects with uncomplicated type 2 diabetes underwent diagnostic testing for silent coronary heart disease by means of adenosine stress myocardial perfusion scintigraphy (SPECT). In these subjects penile arterial flow was simultaneously assessed by PCDU before and after systemic adenosine administration. RESULTS Flaccid PSV showed a significant (r = 0.513, P < 0.0001) correlation with dynamic PSV. Receiver operating characteristic (ROC) curve analysis demonstrated that when a threshold of 13 cm/seconds was chosen, flaccid PSV was predictive for dynamic PSV < 25 and <35 cm/seconds with an accuracy of 89% and 82%, respectively. Among the subset of patients who underwent SPECT, an impaired coronary flow reserve (ICFR) occurred in nine cases (45%). When the same threshold of <13 cm/seconds was chosen, PSV before SPECT was predictive of ICFR with an accuracy of 80% (area under the ROC curve = 0.798 +/- 0.10; P < 0.05). After adjustment for confounders, anxiety symptoms were related to dynamic PSV (Adj. r = -0.154, P < 0.05) but not to flaccid PSV. CONCLUSIONS Our results show that flow in the cavernosal arteries can be routinely evaluated by PCDU in the flaccid state. Performing PCDU only in the flaccid state allows identifying subjects with pathological dynamic PSV with accuracy higher than 80%. Furthermore, our preliminary data suggest that the same examination could identify diabetic subjects with ICFR with an accuracy of 80%.

[1]  S Crown,et al.  A Short Clinical Diagnostic Self-rating Scale for Psychoneurotic Patients , 1966, British Journal of Psychiatry.

[2]  R. Levy,et al.  Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. , 1972, Clinical chemistry.

[3]  S. Zarich,et al.  Silent myocardial ischemia and infarction in diabetics with peripheral vascular disease: assessment by dipyridamole thallium-201 scintigraphy. , 1990, American heart journal.

[4]  K. Sethia,et al.  The role of colour duplex ultrasonography in the diagnosis of vasculogenic impotence. , 1991, British journal of urology.

[5]  E. Meuleman,et al.  Investigation of erectile dysfunction. Diagnostic testing for vascular factors in erectile dysfunction. , 1995, The Urologic clinics of North America.

[6]  A. Isidori,et al.  Anxiety-induced failure in erectile response to intracorporeal prostaglandin-E1 in non-organic male impotence: a new diagnostic approach. , 1996, International journal of andrology.

[7]  M. Mancini,et al.  The presence of arterial anatomical variations can affect the results of duplex sonographic evaluation of penile vessels in impotent patients. , 1996, The Journal of urology.

[8]  G. Habib,et al.  Silent myocardial ischemia in patients with diabetes: who to screen. , 1999, Diabetes care.

[9]  F. Ledda,et al.  Studies on the mechanisms involved in the ATP-induced relaxation in human and rabbit corpus cavernosum. , 1999, The Journal of urology.

[10]  A. Vermeulen,et al.  A critical evaluation of simple methods for the estimation of free testosterone in serum. , 1999, The Journal of clinical endocrinology and metabolism.

[11]  M. Mancini,et al.  Functional adenosine receptors in human corpora cavernosa. , 2000, International journal of andrology.

[12]  A. Fabbri,et al.  Re-dosing of prostaglandin-E1 versus prostaglandin-E1 plus phentolamine in male erectile dysfunction: a dynamic color power Doppler study , 2000, International Journal of Impotence Research.

[13]  D Jacqmin,et al.  Duplex Doppler sonography of the flaccid penis: Potential role in the evaluation of impotence , 2000, Journal of clinical ultrasound : JCU.

[14]  M Mancini,et al.  Duplex ultrasound evaluation of cavernosal peak systolic velocity and waveform acceleration in the penile flaccid state: clinical significance in the assessment of the arterial supply in patients with erectile dysfunction. , 2000, International journal of andrology.

[15]  G. Dohle,et al.  The limited practical value of color Doppler sonography in the differential diagnosis of men with erectile dysfunction , 2002, International Journal of Impotence Research.

[16]  G. Forti,et al.  Structured interview on erectile dysfunction (SIEDY©): a new, multidimensional instrument for quantification of pathogenetic issues on erectile dysfunction , 2003, International Journal of Impotence Research.

[17]  P. Sidhu,et al.  Colour Doppler ultrasound of the penis. , 2003, Clinical radiology.

[18]  P. Fratino,et al.  Relationship Between Erectile Dysfunction and Silent Myocardial Ischemia in Apparently Uncomplicated Type 2 Diabetic Patients , 2004, Circulation.

[19]  M. Giorgi,et al.  Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa. , 2004, Endocrinology.

[20]  G. Forti,et al.  Organic, relational and psychological factors in erectile dysfunction in men with diabetes mellitus. , 2004, European urology.

[21]  Marco M. Ferrario,et al.  La valutazione del rischio cardiovascolare globale assoluto: il punteggio individuale del Progetto CUORE , 2004 .

[22]  E. Laumann,et al.  Sexual problems among women and men aged 40–80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors , 2005, International Journal of Impotence Research.

[23]  I. Thompson,et al.  Erectile dysfunction and subsequent cardiovascular disease. , 2005, JAMA.

[24]  R. Dmochowski,et al.  Chapter 1: The management of erectile dysfunction: an AUA update. , 2005, The Journal of urology.

[25]  P. Valensi,et al.  Markers for silent myocardial ischemia in diabetes. Are they helpful? , 2005, Diabetes & metabolism.

[26]  A. Pagliarulo,et al.  Penile Doppler ultrasound assessment of the cavernous arteries. , 2005, Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica.

[27]  L. Vignozzi,et al.  Peripheral regulatory mechanisms in erection. , 2005, International journal of andrology.

[28]  G. Vannelli,et al.  Testosterone regulates PDE5 expression and in vivo responsiveness to tadalafil in rat corpus cavernosum. , 2005, European urology.

[29]  B. Mitchell,et al.  Screening for silent coronary heart disease in type 2 diabetes: clinical application of American Diabetes Association guidelines. , 2006, Diabetes care.

[30]  E. Greco,et al.  Combining testosterone and PDE5 inhibitors in erectile dysfunction: basic rationale and clinical evidences. , 2006, European urology.

[31]  G. Balercia,et al.  Psycho-biological correlates of free-floating anxiety symptoms in male patients with sexual dysfunctions. , 2006, Journal of andrology.

[32]  F. Montorsi,et al.  EAU Guidelines on erectile dysfunction: an update. , 2006, European urology.

[33]  P. Correia‐de‐Sá,et al.  Corpus Cavernosum from Men with Vasculogenic Impotence Is Partially Resistant to Adenosine Relaxation due to Endothelial A2B Receptor Dysfunction , 2006, Journal of Pharmacology and Experimental Therapeutics.

[34]  F. Montorsi,et al.  Association between erectile dysfunction and coronary artery disease: Matching the right target with the right test in the right patient. , 2006, European urology.

[35]  Rany Shamloul,et al.  ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: Peak Systolic Velocities May Be Falsely Low in Young Patients with Erectile Dysfunction , 2006 .

[36]  G. Balercia,et al.  Psychobiologic correlates of the metabolic syndrome and associated sexual dysfunction. , 2006, European urology.

[37]  G. Forti,et al.  Which patients with sexual dysfunction are suitable for testosterone replacement therapy? , 2007, Journal of endocrinological investigation.

[38]  A. Aversa,et al.  The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. , 2007, The journal of sexual medicine.

[39]  G. Balercia,et al.  ORIGINAL RESEARCH—ENDOCRINOLOGY: NCEP‐ATPIII‐Defined Metabolic Syndrome, Type 2 Diabetes Mellitus, and Prevalence of Hypogonadism in Male Patients with Sexual Dysfunction , 2007 .

[40]  R. Quinton,et al.  The burden of testosterone deficiency syndrome in adult men: economic and quality-of-life impact. , 2007, The journal of sexual medicine.

[41]  G. Balercia,et al.  Low levels of androgens in men with erectile dysfunction and obesity. , 2008, The journal of sexual medicine.

[42]  A. Seftel.  Diagnosis of Erectile Dysfunction , 2008 .

[43]  A. Scholte,et al.  Myocardial Perfusion Scintigraphy With Adenosine: Does It Impair the Left Ventricular Ejection Fraction Obtained With Gated SPECT? , 2008, Clinical nuclear medicine.

[44]  G. Balercia,et al.  Cardiovascular risk engines can help in selecting patients to be evaluated by dynamic penile color doppler ultrasound , 2008, Journal of endocrinological investigation.

[45]  N. Unwin,et al.  Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel on Executive Summary of the Third Report of the National , 2009 .