Vascular Assessment of Erectile Dysfunction

  • Gregory A. Broderick


The discovery that penile erection is a vascular phenomenon the quality of which is adversely affected by identifiable clinical factors coincided with the advent of multiple technologies for penile imaging. The 1980s and 1990s saw the development of many penile diagnostics; of these technologies, color duplex Doppler ultrasound is the least invasive and most informative. Before the wide availability of Doppler technology, a vasoactive penile injection administered in the office permitted the physician to roughly distinguish between severe arterial disease and psychogenic erectile dysfunction (ED). Whether the agent is papaverine, prostaglandin E1, or a combination of vasoactive medications, the addition of duplex Doppler ultrasound provides greater objective criteria for evaluating penile responses.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Blander DS, Sanchez-Ortiz RF, Broderick GA: Sex questionnaires: can they replace etiology specific testing? Urology 1999, 54: 719–723.PubMedCrossRefGoogle Scholar
  2. 2.
    Aboseif SR, Lue TF. Hemodynamics of penile erection. Urol Clin N Am 1988, 15: 1–7.Google Scholar
  3. 3.
    Andersson K-E, Wagner G: Physiology of penile erection. Physiol Rev 1995, 75: 191–236.PubMedGoogle Scholar
  4. 4.
    Sanchez-Ortiz R, Broderick GA: Vascular Evaluation of ED. In Male Sexual Function: A Guide to Clinical Management. Edited by Mulcahy JJ. Totowa, NJ: Humana Press; 2001: 167–199.CrossRefGoogle Scholar
  5. 5.
    Virag R, Frydman D, Legman M, Virag H: Intracavernous injection of papaverine as a diagnostic and therapeutic method in erectile failure. Angiology 1984, 35: 79–87.PubMedCrossRefGoogle Scholar
  6. 6.
    Pescatori ED, Hatzichristou DG, Namburi S, Goldstein I: A positive intracavernous injection test implies normal veno-occlusive but not necessarily normal arterial function: a hemodynamic study. J Urol 1994, 151: 1209–1216.PubMedGoogle Scholar
  7. 7.
    Cormio L, Nisen H, Selvaggi FP, Ruutu M: A positive pharmacological erection test does not rule out arteriogenic erectile dysfunction. J Urol 1996, 156: 1628–1630.PubMedCrossRefGoogle Scholar
  8. 8.
    Elhanbly S, Schoor R, Elmogy M, et al What nonresponse to intracavernous injection really indicates: a determination by quantitative analysis. J Urol 2002, 167:192–196.Google Scholar
  9. 9.
    Aversa A, Isidori AM, Caprio M, et al.: Penile pharmacotesting in diagnosing male erectile dysfunction: evidence for lack of accuracy and specificity. Int J Androl 2002, 25: 6–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Curet P, Grellet J, Perrin D, et al.: Technical and anatomic factors in filling of distal portion of internal pudendal artery during arteriography. Urology 1987, 29:333–338.Google Scholar
  11. 11.
    Bahren W, Gall H, Scherb W, et al.: Arterial anatomy and arteriographic diagnosis of arteriogenic impotence. Cardiovasc Intervent Radiol 1988, 11:195–210.Google Scholar
  12. 12.
    Kawanishi Y, Lee KD, Kimura K, Kojima A, et al Feasibility of multi-slice computed tomography in the diagnosis of arteriogenic erectile dysfunction. BJU Int 2001, 88:390–395.Google Scholar
  13. 13.
    Sanchez-Ortiz R, Broderick GA: Vascular Evaluation of ED. In Male Sexual Function: A Guide to Clinical Management. Edited by Mulcahy JJ. Totowa, NJ: Humana Press; 2001: 167–199.CrossRefGoogle Scholar
  14. 14.
    Govier FE, Asase D, Hefty TR, et al.: Timing of penile color flow duplex ultrasonography using a triple drug mixture. J Urol 1995, 153:1472–1475.Google Scholar
  15. 15.
    Meuleman EJ, Bemelmans BLH, van Asten W, et al Assessment of penile blood flow by duplex ultrasonography in 44 men with normal erectile potency in different phases of erection. J Urol 1992, 147:51–56.Google Scholar
  16. 16.
    Lue TF, Donatuci CF: The combined intracavernous injection and stimulation test: diagnostic accuracy. J Urol 1992, 148: 61–62.PubMedGoogle Scholar
  17. 17.
    Montorsi F, Guazzoni G, Barbieri L, et al The effect of intracorporal injection plus genital and audiovisual sexual stimulation versus second injection on penile color doppler sonography parameters. J Urol 1996, 155:536–540.Google Scholar
  18. 18.
    Pinkstuff DM, Broderick GA: Contemporary management of erectile dysfunction: the challenge for second-generation PDE inhibitors. 3rd Fall Meeting of the Sexual Medicine Society of North America, December 2001. Intl Impot Res 2001, 13: 563.Google Scholar
  19. 19.
    McMahon CG, Daley J: Correlation of duplex ultrasonography, PBI, DICC and angiography in the diagnosis of impotence. Int J Impot Res 1994, 6: A32.Google Scholar
  20. 20.
    Sasteschi LM, Montorsi F, Fabris FM, et al Cavernous arterial and arteriolar circulation in patients with erectile dysfunction: power doppler study. J Urol 1998, 159:428–432.Google Scholar
  21. 21.
    Speel TG, van Langen H, Wijkstra H, Meuleman EJ: Penile duplex pharmacoultrasonography revisited: revalidation of the parameters of the cavernous arterial response. J Urol 2003, 169: 216–220.PubMedCrossRefGoogle Scholar
  22. 22.
    Schwartz AN, Lowe MA, Berger RE et al.: Assessment of normal and abnormal erectile function; color doppler sonography versus conventional techniques Radiol Sci North Am 1991, 180:105–109 Google Scholar
  23. 23.
    Merckx LA, De Bruyne RG, Goes E, et al The value of dynamic color duplex scanning in the diagnosis of venogenic impotence. J Urol 1992, 148:318–320.Google Scholar
  24. 24.
    Teh HS, Lin MB Tsou IY, et al Penile color duplex ultrasonography as a screening tool for venogenic erectile dysfunction. Ann Acad Med Singapore 2002, 31:165–169.Google Scholar
  25. 25.
    Kayigil O, Metin A: Relaxation degree: a new concept in erectile dysfunction Int Urol Nephrol 2001, 32:391–394 Google Scholar
  26. 26.
    Broderick GA: Contemporary management of erectile dysfunction: the challenge for 2nd generation PDE inhibitors. Intl Impot Res 2001, 13: 545.Google Scholar
  27. 27.
    Lue TF, Hricak H, Marich KW, et al.: Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology 1985, 155:777.Google Scholar
  28. 28.
    Padma-Nathan H: My approach to evaluating erectile dysfunction. Contemp Urol 1995, 7: 53–63.Google Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Gregory A. Broderick

There are no affiliations available

Personalised recommendations