Predictive value of cavernosal peak systolic velocity in the flaccid penis

The routine use of intracavernosal injection before Doppler investigation may cause time loss, side effects due to vasoactive agents used and incorrect evaluation in the diagnosis of arterial insufficiency because of psychological inhibition and anxiety. Doppler investigation without intracavernosal injection avoids these pronounced disadvantages. In our study we tried to evaluate whether PSV values prior to intracavernosal injection are predictive in the diagnosis of arterial insufficiency in diabetic and non-diabetic cases. 120 male diabetic (type-2) and non-diabetic patients affected by erectile dysfunction (ED) were enrolled in this study. The Doppler parameters - PSV, end diastolic velocity (EDV) of both cavernosal arteries - were recorded before intracavernosal injection (ICI) (60 mg-2 ml-papaverine hydrochloride (HCl)) and 5, 10 and 30 minutes after ICI into corpus cavernosum. Based on our results we chose 2 cut-off values for the pre-ICI PSV-10 cm/sec and 15 cm/sec. A PSV value less than 25 cm/sec after ICI was used as the diagnostic criteria for arterial insufficiency. We calculated the sensitivity, specificity, positive and negative predictive value of pre-ICI PSV in predicting arteriogenic impotence as diagnosed by post-ICI Doppler sonography. Only type 2 DM patients were included in our study. Statistically significant differences were found in the PSV values before and after ICI, ICI response and EDV values after ICI in both cavernous arteries when diabetic and nondiabetic groups compared. Flow in the cavernosal arteries in the flaccid state could determine nondiabetic patients with vasculogenic impotence with a high accuracy rate.