Penile duplex sonography in the diagnosis of venogenic impotence.

This study tested the hypothesis that measurements of cavernous arterial diastolic velocity and resistance index could provide a quantitative but noninvasive measure of penile corporal venous leakage. Seventy-four men were studied with duplex ultrasonography after intracavernosal injection of 60 mg of papaverine. Fourteen men had normal erection and served as controls. Sixty men had a 1-year history of transient fading or incomplete erections. In all subjects the peak systolic velocity and end-diastolic velocity were measured, and the resistance index was calculated (peak systolic velocity--end-diastolic velocity/peak systolic velocity). Men with normal erections had peak systolic velocities greater than 35 cm/sec and end-diastolic velocities less than 4.5 cm/sec (group 1). Patients with incomplete erections (group II) could be classified into three subgroups. Twenty-three patients with end-diastolic velocities greater than 4.5 cm/sec and normal peak systolic velocities greater than 35 cm/sec were suspected to have corporal venous leakage (group A). Eighteen patients had normal end-diastolic velocities less than 4.5 cm/sec. Twelve of this group had peak systolic velocities less than 35 cm/sec, and six had peak systolic velocities ranging from 37 to 44 cm/sec. These patients were suspected of having arterial insufficiency (group B). Fifteen patients with end-diastolic velocities greater than 4.5 cm and peak systolic velocities less than 35 cm were suspected of having both venous leakage and arterial insufficiency (group C). Twenty-one patients with abnormal diastolic flow underwent infusion pharmacocavernosometry to determine the saline maintenance infusion rate necessary to maintain an intracavernosal pressure of 90 to 100 mm Hg or a full erectile response.(ABSTRACT TRUNCATED AT 250 WORDS)