Penile vascular assessment using color duplex sonography in men with Peyronie's disease

Purpose: We assessed penile vasculature in men with Peyronie's disease using color duplex ultrasound. Materials and Methods: A total of 99 consecutive men with Peyronie's disease underwent duplex ultrasound with 60 mg. intracavernous papaverine to gain an understanding of penile vasculature and its correlation to erectile rigidity. Patients were stratified into groups according to duplex ultrasound vascular parameters and the presence or absence of impotence (that is rigidity adequate for intromission). Results: Of 97 men 31 (32%) complained of impotence, 8 of 99 (8%) had evidence of corporeal veno-occlusive dysfunction on duplex ultrasound (defined as end diastolic flow velocity greater than 4.5 cm. per second) and 43% had a history of vascular risk factors that may have contributed to erectile insufficiency. Impotent patients had decreased peak systolic flow velocity, increased end diastolic flow velocity and a higher percent of vascular risk factors (p = 0.0006, 0.027 and 0.0004, respectively) compared to potent patients. Conclusions: Duplex ultrasound provides a dynamic noninvasive functional assessment of penile vasculature in Peyronie's disease. Although corporeal veno-occlusive dysfunction has been considered the primary vascular etiology of erectile dysfunction associated with Peyronie's disease, arterial insufficiency is a major contributor, which is best detected before definitive therapy.