title: The false diagnosis of venous leak: prevalence and predictors.
abstract: BACKGROUND
  As a vascular test, dynamic infusion cavernosometry (DIC) has lost popularity, and in the urologic community, penile duplex Doppler ultrasound (DUS) has become the sole test to investigate a vascular etiology of erectile dysfunction. Vasoactive agent redosing has been shown to increase the accuracy of DUS.
  
  
  OBJECTIVE
  To define the erectile hemodynamics in men with previously diagnosed venous leak on DUS.
  
  
  METHODS
  Prospective data were collected on patients who (i) had been given a diagnosis of venous leak based on an outside DUS; (ii) elected to undergo a repeat DUS; and (iii) when the repeat DUS suggested venous leak, underwent DIC.
  
  
  METHODS
  DUS: peak systolic velocity and end-diastolic velocity. DIC: flow to maintain.
  
  
  RESULTS
  292 patients were included. Mean ± standard deviation age was 44 ± 26 years. On repeat DUS, 19% (56/292) had completely normal hemodynamics and 7% (20/292) had arterial insufficiency only without venous leak. DIC revealed normal hemodynamics in 13% (38/292), while in 58% (152/292) of patients, the venous leak diagnosis was confirmed. Overall, 47% (137/292) of patients who had been given a diagnosis of venous leak had completely normal hemodynamics, and in only 43% (126/292), the venous leak diagnosis was confirmed upon repeat vascular testing. On multivariable analysis, younger age (<45 years), failure to obtain an adequate erection during the original DUS, and having <2 vascular risk factors were predictive of a false diagnosis of venous leak.
  
  
  CONCLUSIONS
  Penile DUS has a propensity to inaccurately assign a diagnosis of venous leak. Great care should be taken when performing DUS especially in younger men without a significant vascular risk factor history, and the failure to obtain a good erection should make the clinician cautious in assigning a diagnosis of venous leak. Furthermore, there still exists a role for cavernosometry, which appears to have a greater accuracy at diagnosing venous leak.
authors.affiliation: Department of Surgery, St John of God Hospital, Perth, Australia. patrickteloken@gmail.com
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Teloken
authors.forename: Kelly
authors.initials: K
authors.lastname: Park
authors.forename: Marilyn
authors.initials: M
authors.lastname: Parker
authors.forename: Patricia
authors.initials: P
authors.lastname: Guhring
authors.forename: Joseph
authors.initials: J
authors.lastname: Narus
authors.forename: John P
authors.initials: JP
authors.lastname: Mulhall
mesh_terms: D000328:Adult; D000368:Aged; D003951:Diagnostic Errors; D007172:Erectile Dysfunction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging; D015995:Prevalence; D014463:Ultrasonography; D014689:Venous Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D055815:Young Adult