The role of Doppler ultrasound in the diagnosis of vasculogenic impotence

Objective: Many authors have demonstrated that cardiovascular diseases (CVD) and their related risk factors can predict erectile dysfunction (ED). The penile Doppler ultrasonography is a method to evaluate the cavernous blood flow in people with suspected vasculogenic impotence. The goal of our study was to evaluate if erectile dysfunction is associated to a vascular disease and which is the role of penile Doppler investigation. Material and Methods: 90 patients (group 1) complaining ED, but no symptoms of CVD were prospectively evaluated with penile Doppler ultrasound. The controls (group 2) were 45 apparently healthy subjects. Both groups were submitted to carotid and aortal-iliac Doppler ultrasonography. Results: 50 patients (mean age 60.5 ± 4.6 years) in group 1 (IIEF < 15) and 45 subjects (mean age 59.5 ± 4.6 years) in group 2 (IIEF > 15) were recruited. Mean age, height, LDL-cholesterol and blood pressure value were not statistically different (p = 0.417) between the two groups. Statistically significant differences were found in weight values (p = 0.016). Only 8 patients (4%) were affected by arterial insufficiency and 42.1% by veno-occlusive mechanism insufficiency (p > 0.05). The cavernosal artery diameters were within 0.7 ± 0.2 and 1.2 ± 0.1 mm. All patients with a diagnosis of vasculogenic impotence of either arterial or venous origin were found asymptomatically affected by both a diffuse thickenings > 1 mm or a non hemodynamic plaque in the other vessels examined (carotid arteries or aorta or iliac arteries). Discussion: Looking at our results, erectile dysfunction is associated to diffuse thickness > 1 mm or with a non hemodynamic plaque of atherosclerotic origin in other vessels. These data confirm the theory that impotence has to be considered as a risk marker for cardiovascular disease (CVD) in men with no cardiovascular symptoms. In our opinion, the penile echo Doppler is not able to show any endothelial dysfunction in terms of loss of mediator releasing. Conclusion: in case of suspect vasculogenic impotence, even if penile Doppler is not pathological, it would be worth performing a systemic Doppler evaluation of main arteries in order to investigate the presence of atherosclerotic finding and institute a preventive therapy for CVD.