Penile Ultrasound Integral to Diagnosing Erectile Dysfunction Cause

Ultrasound of the penis can play a vital role in determining the underlying cause of erectile dysfunction in men who don’t respond to medication.

Although prescription drugs have significantly – and successfully – changed how providers treat erectile dysfunction (ED), for those men who don’t see improvement, relying on ultrasound can be the key to identifying next steps and possible treatments, according to an article published in the American Journal of Roentgenology.

“Radiologists must be familiar with the imaging protocol, the limitations of the technique, and the interpretations of its findings, to warrant an accurate diagnosis and appropriate patient management,” said lead study author Cristian Gómez Varela, from the radiology department in Complejo Hospitalario Universitario de Pontevedra in Spain. “It is essential to differentiating between the vascular and nonvascular causes of the ED and, therefore, determining appropriate management of the patient.”

The Conditions

When used correctly – with a high-frequency linear array (7.5-12 MHz) and full-length images of the penis in both flaccid and erect states – ultrasound can contribute to successfully diagnosing three vascular-related causes of ED, Varela said.

Peyronie’s Disease (PD): This penile deformity caused by scar tissue that develops after repeated injury results in painful erections. In most cases, MRI is the preferred modality to assess PD. But, gray-scale ultrasound can be very helpful in diagnosis and follow-up, assessing size and location of plaques, detecting small non-palpable lesions or the involvement of the penile septum, or evaluating disease progression. In addition, sonoelastography can estimate tissue stiffness, as well as identify plaques that go undetected on gray-scale ultrasound.

Penile Fracture: Caused by trauma to the penis, usually during sexual intercourse, fracture can cause a rupture in the membrane responsible for trapping blood in the penis to sustain an erection. Ultrasound can make pinpointing any ruptures easier, as fractures are seen as dark breaches in the membrane.

Priapism: This condition can occur in two forms – both high-flow and low-flow. Low-flow priapism is considered a medical emergency as it can cause tissue death and, if left untreated, permanent ED. Ultrasound can identify tissue thickening and scarring in the arteries of the penis, and Doppler ultrasound can also pinpoint inadequate blood retention.

Given its effectiveness is identifying these vascular-related conditions behind ED, according to Varela and colleagues, ultrasound is the preferred method for initially evaluating the penile anatomy and blood flow. Not only is it readily available, but it is minimally invasive and can be well tolerated by patients.