A New method for evaluation in erectile dysfunction: sildenafil + doppler ultrasonography

Among various methods of hemodynamic studies performed in the evaluation of patients with erectile dysfunction, penile color Doppler ultrasonography (CDU) analysis is currently considered the best. However, intracavemous injections (ICI) are invasive and have adverse effects like prolonged erection. The goal of this study was to evaluate whether sildenafil could be used as a subtitute for intracavernousal agents in the evaluation of impotence by CDU. A total of 42 patients with erectile dysfunction underwent CDU before and after 60 mg intracavemous papaverine injection with genital and audiovisual sexual stimulaton. Peak sistolic velocity, end diastolic velocity, resistive index, acceleration time were recorded for twenty minutes after the injection. The same patients underwent CDU following an oral dose of 50 mg sildenafil with genital and audiovisual sexual stimulation in no less than three days after the study with papaverine. The same parameters were measured at 30, 45, 60, 75, and 90 minutes and compared with the values obtained after papaverine injection. Significant increases in mean peak flow velocity were observed following oral sildenafil starting at 30 minutes and achieving a maximum value at 60 minutes. There were no significant differences between the two methods in mean peak velocities at 1, 5, 10 and 20 minutes after papaverine injection and at 30, 45, 60, 75 and 90 minutes after oral sildenafil administrations, if penile CDU with intracavemous papaverine injection is accepted as a gold standard, CDU with sildenafil shows a sensitivity of 90% and selectivity of 100% in demostrating arterial insufficiency. Due to prolonged erections, 5 patients (12%) in the papaverine group required pharmachological detumesence by ICI. No adverse effects were observed with sildenafil. Sildenafil administration achieved increases in peak systolic flow velocities comparable to intracavemous injections. With no prolonged erections, sildenafil emerges as a safer alternative compared to the more invasive intracavernoussal injections. Due to its high sensitivity and selectivity, penile CDU with oral sildenafilholds promise as a potential non invasive technique to evaluate patients with erectile dysfunction. Key Words: Erectile dysfunction, Doppler ultrasonography, sildenafil