Evaluating the feasibility of a new non-invasive technique for improved diagnostics in vascular erectile dysfunction using an ultra-high-resolution ultrasound probe and venous compression: a proof of concept study.

Abstract

Introduction: Erectile dysfunction (ED) is a clinically relevant condition, particularly among older men, with vascular causes such as venous leakage and arterial insufficiency being primary contributors.

Aim: This study aimed to assess the diagnostic accuracy of a novel, non-invasive approach employing ultrasound-guided venous compression to identify the primary vascular etiology in patients with ED.

Methods: A proof-of-concept study was conducted involving 40 male patients with confirmed ED. High-resolution Dynamic Duplex Sonography (DSU) was performed following intracavernosal injection of alprostadil to assess penile blood flow dynamics, including peak systolic velocity (PSV) and end-diastolic velocity (EDV). In 17 patients, a compression ring was individually selected using ultrasound and applied to restrict venous outflow while maintaining arterial inflow. PSV and EDV values were compared between standard DSU and venous compression + DSU (VC-DSU) with an individual selected compression ring. In addition, diagnostic accuracy was validated against CT-arteriography and CT-cavernosography in 10 patients.

Main outcomes measures: The primary outcome was an improvement in diagnostic accuracy of VC-DSU compared to standard DSU.

Results: VC-DSU significantly improved detection of the primary vascular cause in ED, with an accuracy of 90% versus 20% for DSU. Under venous compression, changes in PSV served as key diagnostic markers: a marked increase indicated a venous origin, while stable or varied PSV values distinguished arterial or mixed causes. The accuracy of VC-DSU was comparable to CT cavernosography (P = 0.096), highlighting its potential as a reliable non-invasive alternative.

Clinical implications: VC-DSU offers a non-invasive method to assess vascular contributions to erectile dysfunction with promising diagnostic potential to more accurately identify the vascular cause.

Strengths and limitations: Key strengths of this study include its innovative, non-invasive approach and its direct comparison to cavernosography. However, the limited sample size restricts the generalizability of findings, highlighting the need for larger-scale trials to validate these results. Additionally, patient allocation to VC-DSU and cavernosography was based on willingness to participate rather than a predefined protocol, introducing a potential selection bias.

Conclusion: VC-DSU represents a promising non-invasive and accurate tool that complements traditional diagnostic methods for vascular ED, particularly by enhancing the differentiation of the predominant vascular etiology.