title: Novel Evidence-Based Classification of Cavernous Venous Occlusive Disease.
abstract: OBJECTIVE
  The primary aim of our study was to determine whether an evidence-based rationale could categorize cavernous venous occlusive disease into mild, moderate and severe erectile dysfunction.
  
  
  METHODS
  A total of 863 patients underwent color duplex Doppler ultrasound from January 2010 to June 2013 performed by a single urologist. We identified a cohort of 75 patients (8.7%) with a diagnosis of cavernous venous occlusive disease based on a unilateral resistive index less than 0.9, and right and left peak systolic velocity 35 cm per second or less after visual sexual stimulation. At a median followup of 13 months patients were evaluated for treatment efficacy.
  
  
  RESULTS
  A total of 75 patients with a median age of 60 years (range 19 to 83) and a mean body mass index of 26.3 kg/m(2) (range 19.0 to 39.3) satisfied the criteria of cavernous venous occlusive disease. When substratified into tertiles, resistive index cutoffs were obtained, including mild cavernous venous occlusive disease-81.6 to 94.0, moderate disease-72.6 to 81.5 and severe disease-59.5 to 72.5. Using these 3 groups the phosphodiesterase type 5-inhibitor failure rate (p = 0.017) and SHIM (Sexual Health Inventory for Men) score categories (1 to 10 vs 11 to 20, p = 0.030) were statistically significantly different for mild, moderate and severe cavernous venous occlusive disease. Treatment satisfaction was also statistically significantly different. Penile prosthetic placement was a more common outcome among patients with erectile dysfunction and more severe cavernous venous occlusive disease.
  
  
  CONCLUSIONS
  Our retrospective analysis supports a correlation between the phosphodiesterase type 5 inhibitor failure rate, SHIM score and the rate of surgical intervention using resistive index values. Our data further suggest that an evidence-based classification of cavernous venous occlusive disease by color Doppler ultrasound is possible and can triage patients to penile prosthetic placement.
authors.affiliation: Department of Urology, Mayo Clinic, Jacksonville, Florida; Department of Health Sciences Research (BR, ZL), Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida.
authors.forename: Ram A
authors.initials: RA
authors.lastname: Pathak
authors.affiliation: Department of Urology, Mayo Clinic, Jacksonville, Florida; Department of Health Sciences Research (BR, ZL), Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida.
authors.forename: Bhupendra
authors.initials: B
authors.lastname: Rawal
authors.affiliation: Department of Urology, Mayo Clinic, Jacksonville, Florida; Department of Health Sciences Research (BR, ZL), Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Urology, Mayo Clinic, Jacksonville, Florida; Department of Health Sciences Research (BR, ZL), Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida. Electronic address: Broderick.Gregory@Mayo.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Broderick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D018783:Impotence, Vasculogenic / Q000145:classification* / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology*; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology*; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
keywords: impotence, vasculogenic; penis; phosphodiesterase 5 inhibitors; treatment failure; ultrasonography, Doppler, color