The primary aim of our study was to determine if an evidence based rationale could categorize cavernous venous occlusive disease (CVOD) into mild, moderate and severe erectile dysfunction.
863 patients underwent Color Duplex Doppler Ultrasound (CDDU) from January 2010 to June 2013 by a single Urologist. A cohort of 75 (8.7%) patients with a diagnosis of CVOD based on unilateral Resistive Index < 0.9 and Right and Left post-visual sexual stimulation (VSS) peak systolic velocity (PSV) ≥ 35cm/s were identified. After a median follow-up of 13 months, patients were evaluated for treatment efficacy.
A total of 75 patients (median age 60 (19-83) and mean BMI 26.3 (19.0-39.3)) satisfied the criteria of CVOD. We sub-stratified into tertiles, the following Resistive Index (RI) cutoffs were obtained: mild (81.6 - 94.0), moderate (72.6 - 81.5) and severe (59.5 - 72.5) CVOD. Using these three groups, phosphodiesterase type 5-inhibitor (PDE-5) failure rate (p = 0.017) and Sexual Health Inventory for Men (SHIM) score categories (1-10 vs. 11- 20, p = 0.030) were statistically significantly different for mild, moderate and severe CVOD. Treatment satisfaction was also statistically significant different; penile prosthetic placement was more common outcome among ED patients with more severe CVOD.
Our retrospective analysis supports a correlation between PDE-5 inhibitor failure rate, SHIM score and rate of surgical intervention using resistive index values. Our data further suggests that an evidence-based classification of CVOD by Color Doppler Ultrasound is possible and can triage patients to penile prosthetic placement.
The Journal of urology. 2016 May 06 [Epub ahead of print]
Ram A Pathak, Bhupendra Rawal, Zhuo Li, Gregory A Broderick
Department of Urology, Mayo Clinic, Jacksonville, FL., Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL., Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL., Department of Urology, Mayo Clinic, Jacksonville, FL. Electronic address: .