The Efficacy of Penile Duplex Ultrasound in Erectile Dysfunction Management Decision-Making: A Systematic Review.

Introduction: The diagnosis of erectile dysfunction (ED) often involves a combination of patient history, questionnaire responses, and laboratory results. Penile duplex ultrasound (PDU) with intracavernous injection of papaverine was introduced as a noninvasive tool to aid in the evaluation of penile circulation. Although PDU is widely used in the initial workup of ED, the true value and effect of PDU on management is still unclear.

Objective: The objective of this systematic review was to determine if PDU affects ED management.

Methods: A systematic literature review was conducted using PUBMED-Medline databases in June 2020, which included literature from 1991 through 2019. The search strategy used MeSH terms "penile", "duplex ultrasound", or "duplex ultrasonography". The database process yielded a total of 389 terms. Systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.

Results: 6 studies were included in the final analysis and included a total of 386 patients. These articles each discussed the clinical utility of PDU using venous and arterial parameters and correlated treatment response to sexual functioning questionnaires. The majority of the studies demonstrated PDU was unnecessary for diagnosis and ultimately did not affect treatment decision-making.

Conclusion: PDU generally does not change management in men with established organic ED but may prove useful in special populations such as in younger patients or patients with anatomical abnormalities. Limitations include the small number of focused studies on the topic and paucity of randomized trials investigating PDU and clinician decision-making. Further investigations and studies are needed to determine if PDU modifies ED provider's management decision-making. Nashed A, Lokeshwar SD, Frech F, et al. The Efficacy of Penile Duplex Ultrasound in Erectile Dysfunction Management Decision-Making: A Systematic Review. Sex Med Rev 2021;9:472-477.