Penile Doppler Study

What it evaluates It measures blood flow in the penile arteries and veins after pharmacologic stimulation (usually an intracavernosal injection such as prostaglandin E1).

The study helps distinguish:

Arterial insufficiency (arteriogenic ED) – Reduced inflow due to atherosclerosis, diabetes, smoking, trauma, or pelvic surgery. – Key parameter: low peak systolic velocity (PSV).

Venous leak (veno-occlusive dysfunction) – Failure to trap blood within the corpora cavernosa. – Key parameter: elevated end-diastolic velocity (EDV) despite adequate arterial inflow.

Mixed vascular disease – Both arterial and venous abnormalities. Structural abnormalities – Fibrosis, plaques (e.g., Peyronie’s disease), cavernosal scarring, or post-traumatic changes. Psychogenic ED (indirectly) –

Normal Doppler parameters with poor erection response may suggest a non-organic component. Typical protocol Baseline ultrasound (flaccid state). Intracavernosal vasoactive injection.

Serial Doppler measurements at 5–20 minutes. Assessment of rigidity and hemodynamics.

Key diagnostic thresholds (commonly used) Normal arterial inflow: PSV ≥ 30 cm/s Borderline: 25–30 cm/s Arterial insufficiency: < 25 cm/s Venous leak suggestion: EDV > 5 cm/s with inadequate rigidity Resistive index (RI): < 0.75 may indicate veno-occlusive dysfunction (Exact cutoffs vary slightly by lab and protocol.)

When it is most useful Young men with suspected vascular injury or trauma Poor responders to PDE5 inhibitors

Pre-surgical planning (revascularization or implant considerations) Medico-legal documentation

Complex ED with unclear etiology Concomitant penile deformity or fibrosis Limitations Operator dependent

Anxiety or inadequate pharmacologic response can confound results

Not always necessary in straightforward cases (e.g., clear psychogenic ED or obvious systemic vascular disease)

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