How can a radiologist reveal more practical information using dynamic study of cavernosal artery after injection of...

Erection is a dynamic multi-stage neurovascular phenomenon consisting of 4 phases. Conventional protocol of color Doppler study can easily overlook these ongoing dynamic events.

Here, we tried to designate patterns for these dynamic spectral waveform changes of cavernosal arteries in patients with erectile dysfunction and subsequently better describe the extent of their underlying problem.

We evaluated 59 men who were referred for post-intracavernosal injection (ICI) color Doppler investigation of suspected erectile dysfunction (ED). The demographic data and medical history were recorded. Afterwards, first scan injection was done. Then scanning of cavernosal arteries was started about one minute after the injection and was continued thereafter. For better description of temporal changes in the waveform of cavernosal arteries, new patterns were defined and used. Patients were also classified based on previously known etiologic categories (i.e. arterial insufficiency, venous leak, mixed type, and normal response).

The mean age was 45.6 ± 13.1 (24 to 74 ) years. Twenty-two were normal responders [considered as non-organic causes (37.3% of all patients)], 27 were classified as venous leakage, eight had arterial insufficiency and two were mixed type. Maximum PSV occurred before the fifth minute in 47 patients (92.2%). Eight patients completed all phases of erection in the first 5 minutes. We defined 8 patterns for the temporal changes in cavernosal arterial waveform. Pattern 5 was the most common pattern of venous leak; while, patterns 3 and 4 were considered as the uncommon group. Six patients demonstrated the uncommon patterns of venous leak (22.2%). Hypertension was more prevalent in the uncommon pattern of venous leak.

We highlight the considerable role of continuous evaluation starting one minute after intra cavernosal with ICI injection of the vasoactive agent for better description of the underlying pathologies of ED especially in patients with venous leak etiology.