Duplex Doppler Evaluation of Cavernous Venous Insufficiency in Patients with Erectile Dysfunction in Abuja, Nigeria

Cavernous venous insufficiency (CVI) is a common cause of medical treatment failure in patients with erectile dysfunction (ED). Endothelial dysfunction and replacement of cavernosal smooth muscles by collagen fibres affect expansion of the cavernous sinusoids with attendant poor compression of the emissary veins against the tunica albuginea which results ultimately in venous leak. This study was aimed at using duplex Doppler sonography to evaluate the pattern of findings in patients with CVI in our facility.

This prospective study was conducted from August 2017 to January 2023 at the Federal Medical Centre, Abuja, and the University of Abuja Teaching Hospital, Abuja. Twenty-nine consecutive patients aged 30-65 years, with clinical diagnosis of ED who did not respond well to medical treatment, were evaluated with duplex Doppler ultrasound scan of the penis. Following intracavernosal injection of prostaglandin E₁, the spectral waveforms as well as peak systolic velocity (PSV) and end diastolic velocity of the cavernosal artery (CA) were recorded at 5 min intervals till 30 min post-injection.

The age range of the participants was 30-65 years (mean = 46.7 ± 16.2 years), while those with CVI were 42-62 years (mean = 54.3 ± 7.8 years). All the participants had normal arterial inflow with PSV of CA above 25 cm/s. CVI was observed in 10 patients (34.5%), and increasing age was found to be a major factor in the aetiology of CVI.

CVI was observed in many of our patients, and they were all above 40 years of age which suggests ageing as an important factor in its aetiology. Colour Doppler assessment of the penis is therefore recommended in every patient with ED before initiating treatment, as that will aid patients' selection for targeted therapy and, by extension, avert treatment failure.