Diagnostic value of multi-modal ultrasound combined with intracavernosal injection testing for concurrent erectile dysfunction and penile curvature

Background The combination of Intracavernosal Injection (ICI) and Color Doppler Duplex Ultrasonography (CDDU) has emerged as a novel approach for evaluating erectile dysfunction (ED) in recent years. Aim To evaluate the diagnostic value of multi-modal ultrasound integrated with ICI in patients with ED concomitant with penile curvature. Methods Eighty-two ED patients were prospectively enrolled in this observational study between April 2021 and February 2025. Multimodal ultrasound, including high frequency ultrasound, CDDU, and shear wave elastography were used to evaluate the penile hemodynamic and structural parameters pre- and post-ICI of Papaverine Hydrochloride. The peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) of the corpus cavernosum artery and SWE-derived Young’s modulus values (YM) of the corpus cavernosum were examined. Participants were stratified by curvature presence, with subgroup analyses by different angle (<15°, 15-30°, 31-60°, >60°) and different direction (ventral/lateral, left/right). Outcomes The differences of penile hemodynamic and structural parameters pre- and post-ICI of all ED patients, and different subgroups of patients with penile curvature were evaluated. Results (1) Eighty-two men with a median age of 34 (21-67) years were evaluated, including 34 patients (41.46%) diagnosed as ED with penile curvature and 48 patients (58.54%) diagnosed as ED without penile curvature. (2) Using High-frequency ultrasound, Peyronie’s disease was detected in 8 patients (9.76%). (3) Following ICI, compared to pre-ICI measurements, both groups exhibited significant increases in PSV (P < .001) and EDV (P = .012) of cavernous artery and a reduction in YM (P < .001). (4) Patients in moderate/severe curvature group showed higher EDV (P = .01) and lower RI (P = .02) than no/mild curvature groups, with Significant differences. (5) Significant differences in pre-ICI YM were observed among patients categorized by penile curvature direction (P = .03). Clinical Implications We provide a non-invasive, reproducible method for the integrated assessment of ED complicated with penile curvature by multi-modal ultrasound combined with ICI, and correlate pre-intervention biomechanical and vascular profiles with post-erection anatomical outcomes in ED patients. Strengths & Limitations The strength of the study lies in its unique approach to evaluate patients with ED concomitant with penile curvature, making the clinical evaluation more complete and precise. However, the limited sample size restricts generalizability and further research. Conclusion Multi-modal ultrasound combined with ICI provides a non-invasive, reproducible method for the integrated assessment of ED complicated with penile curvature.