Abstract Introduction Erectile dysfunction (ED) is a frequent and distressing complication following prostate cancer treatment (PCT). When properly conducted, Penile Duplex Doppler Ultrasound (PDDU) can offer valuable prognostic information. However, rigorous protocols are time-consuming and demand expertise. This study aims to describe PDDU findings in patients with refractory ED post-PCT. Methods We reviewed medical records of men with refractory ED post-PCT who underwent PDDU in a tertiary center. Exams were performed by a single high-volume radiologist using a standardized protocol including intracavernosal injection (papaverine 30 mg/ml + fentolamine 1 mg/ml + alprostadil 10mcg/ml), redosing, and rigidity assessment. Peak systolic velocity (PSV) 30 cm/s defined insufficient arterial inflow (IAI); end-diastolic velocity (EDV) 5 cm/s defined corporal veno-occlusive dysfunction (CVOD). In order to gain statistical strenght, patients were divided by PCT: Group 1 (radical prostatectomy only) and Group 2 (radiotherapy with or without other treatments). Results We analyzed 48 PDDU exams (median age 67.5). Trimix was used in all but 3 patients (median total dose 40 IU). Redosing was needed in 25 cases; 11 required the stress dose of 100 IU and 8 required reversal. Despite refractory ED, 30 patients (62%) had normal PDDU, suggesting neurogenic ED; 9 had IAI, 8 CVOD, and 1 was inconclusive. Group 1 (n = 30): 18 (60%) normal, 6 (20%) IAI, 6 (20%) CVOD. Group 2 (n = 18): 9 (56%) normal, 4 (25%) IAI, 2 (12.5%) CVOD, 1 (6.5%) inconclusive. No statistical difference was found. Conclusions ED post-PCT may result from neurogenic or vasculogenic causes. A well-executed PDDU aids in prognostic stratification and guides individualized management. Financing No conflict.
Horta et al. (Sun,) studied this question.