Abstract
The role of penile dynamic colour Doppler duplex ultrasound (CDDU) is debated throughout the diagnostic work-up of men with erectile dysfunction (ED). The association between ED and lifestyle’s habits has been studied in literature. In this study we aimed to assess the predictive value of mean systolic velocity at 5 minutes with clinical and lifestyle factors, for detecting pathological CDDU outcomes in ED patients.
CDDU data from 365 consecutive ED patients were prospectively collected at a single academic center. Baseline data included: age, total cholesterol levels, BMI, cigarette smoking and alcohol habits. The atherosclerotic cardiovascular disease score (ASCVD) was applied to the entire cohort. CDDU was performed after intra-cavernosal injection of alprostadil 20 ug and sexual stimulation in all patients. Mean peak systolic velocity (PSV) between right and left artery at 5 minutes were calculated in all patients. PSV < 35 cm/s and/or resistance index <0.85 were considered pathological. Logistic regression analysis was used to model predictors of pathological CDDU outcomes. The predictive model for a pathological CDDU was assessed with ROC analysis.
Median age was 53 years (41.8–60) and BMI was 25.7 (23.2–27.8) kg/m2. The median total cholesterol value was 189 mg/dL. 37.6% men were smokers and 78.4% consumed alcohol. Higher mean PSV at 2 minutes was associated with a lower likelihood of a pathological CDDU result (p = 0.003). Smoking (p = 0.069) and alcohol (p = 0.058) emerged to be associated with a healthier CDDU outcome among non-smokers and with lower alcohol use. Age, BMI, and ASCVD risk, did not show any statistically significant association. Fig. 1 shows the ROC analysis for the combined model (mean 5 minutes PSV with smoking and alcohol use). An area under the curve (AUC) of 0.84 demonstrated a high predictive accuracy for a pathological CDDU.
In patients with ED at CDDU, a lower mean PSV at 5 minutes with smoking and alcohol consumption is a reliable predicting factors of pathological CDDU outcomes. These findings can guide the diagnostic work-up when PSV at 20 minutes is not reliable because of the inability to obtain an erection.
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