The role of imaging in the diagnostic evaluation of impotence

This article serves to highlight the recent advances that have been made in the workup and differential diagnosis of erectile dysfunction, focusing particularly on the role of imaging in this diagnostic assessment. Intracavernosal injection of vasoactive agents, duplex sonography with pulsed Doppler analysis, penile arteriography, and dynamic infusion pharmacocavernosometry/cavernosography are among the techniques discussed. With the development and availability of nonprosthetic treatment options, identification of the specific underlying cause of a patient's impotence (as determined by these methods) allows the formulation and institution of a therapeutic plan based on the patient's underlying pathophysiology and appropriate for the individual's case. On the basis of our experience, we present a practical and cost-effective algorithm for the diagnostic evaluation of the impotent patient.