Comparison of penile duplex ultrasonography to pudendal arteriography. Variant penile arterial anatomy affects interpretation of duplex ultrasonography.
OBJECTIVE
Duplex ultrasonography is currently used as a noninvasive imaging modality for the functional evaluation of penile blood flow in impotent men. However, the accuracy of this test is controversial. The objective of this study was to determine the sensitivity and specificity of duplex ultrasonography, to assess the ultrasonographic parameters most predictive of arterial disease, and to evaluate the causes of misinterpretation of duplex ultrasound studies.


METHODS
Duplex ultrasonography and pudendal arteriography were performed on 42 impotent men during a 4-year prospective study. The predictive power of the following ultrasonographic parameters were analyzed: cavernosal arterial diameter, peak blood flow velocity, and pulsations on real-time ultrasonography.


RESULTS
The results of both studies were concordant in 81% of the patients with a 77% sensitivity and 85% specificity for ultrasonography when using arteriography as the gold standard. Arterial pulsations and peak blood flow velocity were most predictive, whereas dilation was not helpful. Variant penile arterial anatomy was present in 83% of the patients and was the most frequent cause of misinterpretation of duplex ultrasonography.


CONCLUSIONS
Duplex ultrasonography is a fairly reliable screening test for arterial disease in impotent men. Visualization of arterial pulsations and measurement of peak blood flow velocity are the best predictors of arterial function. Awareness of the potential arterial anomalies may help reduce misinterpretation of ultrasonography. Arteriography is necessary in any patient being considered for penile arterial surgery because of the high frequency of anatomic variations.
Jarow
J P
JP
Department of Urology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1094.
Pugh
V W
VW
Routh
W D
WD
Dyer
R B
RB
D000328:Adult; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001158:Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D007172:Erectile Dysfunction / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography