Unreliability of the Duplex Scan in Diagnosing Corporeal Venous Occlusive Disease in Young Healthy Men With Erectile Deficiency

To define the role of cavernosal venous occlusive dysfunction (CVOD) as the only cause of erectile dysfunction (ED). Patients meeting the CVOD criteria without any risk factors for organic ED were randomized into 2 groups; the end-diastolic velocity (EDV), peak systolic velocity (PSV), and resistive index (RI) of their cavernosal arteries were assessed using color duplex Doppler ultrasound (CDDU) after intracavernous injection (ICI) of 10 µg alprostadil. Group 1 (153 patients) underwent repeated CDDU + ICI assessments (a maximum of 3 rounds). Group 2 (149 patients) underwent CDDU + ICI before and after sexological counseling. The percentage data were analyzed using the Cochran-Mantel-Haenszel test; the numerical data were analyzed using the Wilcoxon test. For group 1, the PSVs (median values: first round 42 cm/s; second round 54 cm/s; third round 66 cm/s) and RIs (median values: first round 70%; second round 89%; third round 92%) increased significantly in each CDDU + ICI round, whereas the EDVs were significantly lower (median values: first round 11 cm/s; second round 5 cm/s; third round 1 cm/s). For group 2, the PSVs (median values: from 44 to 67 cm/s) and RIs (from 72% to 93%) increased significantly after sexological counseling, whereas the EDVs (median values: from 12 to 1 cm/s) were significantly lower. Repeated CDDU + ICI and counseling strongly diminished the percentage of patients meeting the CVOD criteria, leading to the suspicion that CVOD is linked to psychological issues in highly selected young healthy men with ED.