Abstract
Traditionally, it was thought that the pathogenesis of erectile dysfunction (ED) can be divided into psychological and organic factors. However, recent literature supports the development and progression of ED due to multidimensional alterations of a complex interplay of central and peripheral systems, from neural cognitive and efferent networks to loco-regional neuro-hormonal factors which are responsible for impaired penile vascular hemodynamics and ensuing lack of, or suboptimal, blood flow into the penis and/or veno-occlusive dysfunction. It is recognised that ED is strongly correlated with cardiovascular health and published clinical guidelines advocate screening for cardiovascular and metabolic risk factors in men presenting with ED. Over the past few decades, various imaging modalities have been developed and utilised to provide objective evaluation for ED to better characterise the state of penile health and exclude psychogenic components. The following article evaluates current and emerging imaging diagnostic tools for ED.
Highlights
Erectile dysfunction (ED) is defined as the persistent inability to attain and/or maintain an erection sufficient for sexual intercourse [1]
Clinical parameters such as cavernous arterial diameter, the direction of blood flow, peak systolic velocity (PSV), acceleration time, end diastolic velocity (EDV) and resistance index provides a measurement of the underlying penile hemodynamics [4]
The main objective of cavernosometry is to record the relationship between corpus cavernosum infusion rate required to sustain an intracavernosal pressure that equals the mean arterial systemic blood pressure, while cavernosography identifies the specific location of cavernous venous leak [9]
Summary
Erectile dysfunction (ED) is defined as the persistent inability to attain and/or maintain an erection sufficient for sexual intercourse [1]. Penile CDU is usually performed with concurrent use of intracavernosal vasoactive drug(s) injection to provide adequate penile erection at the time of imaging study. Clinical parameters such as cavernous arterial diameter, the direction of blood flow, peak systolic velocity (PSV), acceleration time, end diastolic velocity (EDV) and resistance index provides a measurement of the underlying penile hemodynamics [4]. Published studies correlating post-occlusive vasodilation of cavernous arteries in men with ED may provide a functional assessment of cavernosal endothelium state [7], controversies exist whether this finding is related to the direct effect of tissue ischemia or an increase in shear stress of the endothelial wall from occlusion of the vascular flow
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