(629) Does Penile Doppler Ultrasound Influence Treatment Decisions in the Management of Erectile Dysfunction and Peyronie’s Disease? – A Retrospective Review

Introduction Both erectile dysfunction (ED) and Peyronie’s disease (PD) are common conditions with significant negative sequalae on men’s physical, social and psychological health. Both the European Association of Urology (EAU) & American Association of Urology suggests the use of penile doppler ultrasound (PDUS) can be used as a second line investigation in diagnosis and aiding preoperative planning. Objective To understand the role of penile doppler in the local management of erectile dysfunction and Peyronie's disease. Methods A two-year retrospective review of all patients with erectile dysfunction or Peyronie’s disease who underwent a penile doppler at two tertiary andrology referral centres from April 2023 was performed. Results 60 patients underwent penile doppler as part of management for erectile dysfunction or Peyronie’s disease. These patients had an average age of 52 years (range 37-59 years). 16 (27%) patients had pre-existing mental health conditions, most predominantly anxiety (11, 18%), and 29 (48%) had significant physical health conditions recorded including hypertension, diabetes and high cholesterol. 44 (73%) patients reported erectile dysfunction and 25 (42%) patients reported symptoms consistent with Peyronies disease. 32 (53%) of patients had trialled treatment for ED prior to ultrasound. Of these patients, 20 (60%) had had testosterone levels measured, with only 4 having detailed studies measuring free testosterone. Only 2 had high testosterone (>27), and none fell below 6. 36 (60%) had a recorded HbA1c and 23 (38%) had a recorded testosterone level. No patients were recorded as having completed the SHIM or IIEF-EF. 26 (60%) of patients underwent the doppler for EAU recognised indications, with the most common indication being PD and considering surgery (23, 38%) All scans were performed by a specialist uroradiologist whilst in one of the centres all were performed jointly with a urologist and radiologist (28, 47%) Doppler results were normal flow in 52 cases (87%), demonstrated arterial insufficiency in 6 (10%) whilst the rest identified a potential venous leak or mixed arterial and venous dysfunction. Following PDUS 25 (42%) of patients were discharged, 14(23%) were referred to psychosexual counselling, 9 (15%) were listed for penile straightening surgery, 6 (10%) were listed for a penile prosthesis and 3 (5%) were referred to a super regional referral centre. Although a subjective measure, it appeared the Doppler influenced treatment in 33 (55%) of cases. Most commonly related this was thought as an aid to patient counselling or planning for PD surgery. Conclusions Overwhelmingly, patients referred for PDUS had normal results. For those who had abnormal results, it is not clear if it changed management. Psychogenic ED appears to be the dominant aetiology. Normal PDUS may provide reassurance to those patients not requiring further intervention and aid the counselling process and planning for PD surgery. Our data would suggest most men do not require PDUS and should be counselled about the likely consequences of a normal test. Disclosure No