Doppler Evaluation of Erectile Dysfunction - Part 1

D Golijanin; E Singer; R Davis; S Bhatt; A Seftel; V Dogra

Disclosures

Int J Impot Res. 2007;19(1):37-42. 

In This Article

Basic evaluation

Patients with ED undergo a preliminary assessment designed to address significant diseases such as diabetes, coronary artery disease (CAD) and hypertension before starting therapy, so non- or/and least invasive treatments are to be used first.[4,5,6] A basic diagnostic evaluation is the first step in ED assessment and is applied for the majority of men, whereas specific diagnostic procedures are implemented in a smaller subset of patients.[7,8] The basic evaluation is often commenced by the primary care physicians. Occasionally, a number of patients are diagnosed and treated by cardiologists, neurologists, endocrinologists and psychiatrists, who treat ED as a comorbidity of an underlying disease.[9,10]

Basic evaluation includes thorough medical, sexual and psycho-sexual history, physical examination and limited laboratory assessment. Radiological imaging in the field of ED has diminished in importance over the past 10 years with the introduction of new effective oral therapies and the recognition that surgical treatment of both penile venous leak and arterial insufficiency have poor long-term clinical outcomes. The introduction of phosphodiesterase-5 (PDE5) inhibitors has revolutionized the therapeutics of ED and radically changed the way in which men with ED are assessed and investigated.[11] Documentation of a good quality erection in response to a PDE5-inhibiting drug confirms grossly adequate arterial flow and patent veno-occlusive mechanisms. However, color Doppler ultrasound continues to have a role in the evaluation of specific patients with ED and has an increasing role in the detection of silent CAD in men presenting with ED.[12]

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