The use of penile Doppler ultrasonography in the detection of vascular erectile dysfunction

Abstract

Background: Erectile dysfunction is defined as the inability to get sufficient erection for a satisfactory sexual intercourse. Penile erection is a complex phenomenon that involves a coordinated interaction of psychological, hormonal, nervous, arterial, venous and sinusoidal systems. According to recent studies, on average about 10% of men aged 40–70 years have severe or complete erectile dysfunction, and about 20–40% – partial erectile dysfunction. According to the 2018 European Association of Urologists (EAU) Guide, up to 12% of the European male population up to the age of 40 has a certain degree of erectile dysfunction (from minor to severe), after 40 years, this figure exceeds 50%. The prevalence of erectile dysfunction (ED) in the Republic of Moldova is significantly higher in men over the age of 40–67.4%, compared to men up to the age of 40–21.1%. Imaging-directed Doppler ultrasound of the cavernous arteries provides a functional and quantifiable assessment of the arterial flow of the penis during a pharmacological erection. Subjects without vascular disease show arterial dilation after intracavitary injection, the vessels appearing with thin and parallel walls, homogeneous lumen and following a straight course, subjects with arteriogenic problems had thickened walls and an inhomogeneous lumen. It is also mentioned that no differences were observed between the two drugs. At the same time, to achieve maximum erection using intravenous injections with a vasodilator is a sign of the veno-occlusive cause, which is independent of both penile stiffness and tumescence. Patients with arterial insufficiency were relatively older than other patients. They also had complicated medical conditions for diabetes and hypertension. Conclusions: Vascular etiologies are important contributors to erectile dysfunction. Arterial insufficiency is suspected with poor blood flow, while venoocclusive dysfunction is lower in the face of adequate blood flow and poor erectilesponse.