Duplex ultrasound evaluation of cavernosal peak systolic velocity and waveform acceleration in the penile flaccid state: clinical significance in theassessment of the arterial supply in patients with erectile dysfunction

The aim of this paper was to establish if duplex ultrasound parameters obta ined for assessment of the patency of cavernosal arteries in the penile fla ccid state can give sufficient clinical information without the use of intr acavernosal injection of vasodilatory drugs. We assessed mean cavernosal pe ak systolic velocity (PSV) in the penile flaccid state (basal PSV), and aft er PGE1 injection (dynamic PSV) in 339 unselected patients with erectile dy sfunction. In 55 of these patients the waveform acceleration in the flaccid state was also assessed. The results of the study can be summarized as fol lows: (1) a significant relationship was found between basal and dynamic PS V in the 339 patients (r=0.477; p < 0.0001); (2) a basal PSV > 12.5 cm/sec was predictive of a dynamic PSV greater than or equal to 30 cm/sec in 129/1 39 (92.8%) of the patients, whereas in patients with a basal PSV less than or equal to 12.5 a dynamic PSV both > or < 30 cm/sec could be found; and (3 ) an acceleration > 1 m/sec(2) in the flaccid state was coupled to a dynami c PSV > 30 cm/sec in 43/46 (93.5%) of the patients independent of the basal PSV. In conclusion, these results suggest that the combined duplex ultraso und assessment of PSV and waveform acceleration in the penile flaccid state can predict arterial dynamic inflow in the majority (51/55; 92.7%) of pati ents with erectile dysfunction, with less time and expense and less discomf ort for the patient.