COLOR-FLOW AND SPECTRAL DOPPLER IMAGING AFTER PAPAVERINE-INDUCED PENILE ERECTION IN 220 IMPOTENT MEN - STUDY OF TEMPORAL PATTERNS AND THE IMPORTANCE OF REPEATED SAMPLING, VELOCITY ASYMMETRY AND VASCULAR ANOMALIES

Of 220 impotent men studied, 52 demonstrated venous leakage, 85 had ar terial insufficiency and 65 showed normal vascular response. Persisten t diastolic velocity > 7 cm/s diagnosed venous leakage with a sensitiv ity of 94% and a specificity of 69%, using cavernsonography as the ref erence standard. Using clinical response as the reference standard max imal systolic velocity of 30 cm/s identified normal penile arterial re sponse with a sensitivity of 96% and specificity of 82%. There was a g ood correlation between penile arterial insufficiency and a strong his tory of arteriopathy. Time to peak systole > 0.1 s was a reliable pred ictor of arteriogenic impotence and Pulsatility Index (PI) < 300 was d iscovered only in patients with either venous leakage or arteriogenic impotence. Peak systolic velocity (T(max)) occurred between 5.2 and 6. 5 min after injection, and diastolic velocity was minimal at 9 min wit h only the normal responders showing reversed diastolic flow. However, 22% had a delayed response (T(max) range 1-18 min). Velocity asymmetr y was equally common in the three groups and unilateral sampling would have misdiagnosed 6% of patients studied. Vascular anomalies were see n in 13%, particularly a single feeding artery, dorsal vein flow or co llateral arterial flow.