Abstract Background Arteriogenic insufficiency (AI) is the most common vascular cause of erectile dysfunction (ED) and is traditionally diagnosed using semi-invasive papaverine-induced penile Doppler ultrasonography (P-PDUS). Aim To evaluate the feasibility and diagnostic accuracy of the cavernosal artery ondulation index (CA-OI) measured during the flaccid penile phase for identifying AI in men with ED. Methods This prospective study included 90 men with clinically confirmed ED (International Index of Erectile Function-5 ≤ 25) and suspected vascular etiology. Gray-scale and color Doppler ultrasonography were performed in the flaccid state to measure CA-OI. AI was diagnosed according to established P-PDUS criteria, and patients were classified into AI (n = 28) and non-AI (n = 62) groups. CA-OI values were compared between groups, and receiver operating characteristic curve analysis was used to evaluate diagnostic performance. Outcomes The primary outcome was the diagnostic accuracy of flaccid-phase CA-OI for detecting AI. Results Patients with AI were significantly older than those without AI (59.8 ± 8.8 vs. 46.4 ± 13.5 years, P .001) and had a higher prevalence of diabetes mellitus (P .001). Mean CA-OI values were significantly higher in the AI group (2.76 ± 0.28 vs. 2.33 ± 0.17, P .001). Receiver operating characteristic analysis demonstrated excellent diagnostic performance, with an area under the curve of 0.906. A CA-OI cut-off value of 2.46 yielded 89.3% sensitivity and 79% specificity for identifying AI. Clinical Implications Measurement of CA-OI in the flaccid phase offers a non-invasive and clinically practical approach for the initial screening of arteriogenic ED, potentially reducing the need for intracavernosal injection. Strengths and Limitations The principal strength of this study is the first evaluation of CA-OI as a non-invasive diagnostic marker obtained during the flaccid penile phase; limitations include the single-center design and the use of P-PDUS rather than angiography as the reference standard. Conclusion CA-OI measured during the flaccid penile phase is a highly accurate, non-invasive marker for AI in men with ED.
Tuzcu et al. (Thu,) studied this question.