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Phentolamine re-dosing during penile dynamic colour Doppler ultrasound: a practical method to abolish a false diagnosis of venous leakage in patients with erectile dysfunction

Departments of ¹ Urology and ² Radiology, King's College Hospital, Denmark Hill, London SE5 9RS and ³ Institute of Psychiatry and Biostatistics, Guy's, King's and St. Thomas' School of Medicine, King's Denmark Hill Campus, King's College Hospital, London SE5 9RS, UK

View larger version (35K): [in a new window]   Figure 1. (a) Following an intracavernosal injection of prostaglandin E1, at 15 min the peak systolic velocity of the right cavernosal artery measures 55.4 cm s–1 and the end diastolic velocity remains above the baseline, measuring 2.4 cm s–1. The degree of tumescence is suboptimal. (b) Following intracavernosal phentolamine (2 mg), the peak systolic velocity increases to 75.7 cm s–1, but the end diastolic velocity demonstrates flow reversal (measured at –5.4 cm s–1). This corresponds to a good degree of tumescence suggesting that the apparent leak in this patient was not structurally based but could be functional.

View larger version (45K): [in a new window]   Figure 2. (a) Spectral Doppler ultrasound, at 15 min following 20 µg prostaglandin E1, demonstrates an excellent arterial response (peak systolic velocity=77.1 cm s–1) but a high forward diastolic flow of 16.7 cm s–1, suggesting the presence of a venous leak. (b) Following the administration of 2 mg intracavernosal phentolamine, there is no change of the spectral Doppler ultrasound waveform, with a slight rise in the peak systolic velocity to 89.4 cm s–1. There is little change in the end diastolic velocity (17.5 cm s–1), suggesting the presence of a "true" venous leak.