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J Sex Med. 2011 Aug;8(8):2344-9. doi: 10.1111/j.1743-6109.2011.02298.x. Epub 2011 May 13.

The false diagnosis of venous leak: prevalence and predictors.

Author information

1
Department of Surgery, St John of God Hospital, Perth, Australia. patrickteloken@gmail.com

Abstract

INTRODUCTION:

As a vascular test, dynamic infusion cavernosometry (DIC) has lost popularity, and in the urologic community, penile duplex Doppler ultrasound (DUS) has become the sole test to investigate a vascular etiology of erectile dysfunction. Vasoactive agent redosing has been shown to increase the accuracy of DUS.

AIM:

To define the erectile hemodynamics in men with previously diagnosed venous leak on DUS.

METHODS:

Prospective data were collected on patients who (i) had been given a diagnosis of venous leak based on an outside DUS; (ii) elected to undergo a repeat DUS; and (iii) when the repeat DUS suggested venous leak, underwent DIC.

MAIN OUTCOME MEASURES:

DUS: peak systolic velocity and end-diastolic velocity. DIC: flow to maintain.

RESULTS:

292 patients were included. Mean ± standard deviation age was 44 ± 26 years. On repeat DUS, 19% (56/292) had completely normal hemodynamics and 7% (20/292) had arterial insufficiency only without venous leak. DIC revealed normal hemodynamics in 13% (38/292), while in 58% (152/292) of patients, the venous leak diagnosis was confirmed. Overall, 47% (137/292) of patients who had been given a diagnosis of venous leak had completely normal hemodynamics, and in only 43% (126/292), the venous leak diagnosis was confirmed upon repeat vascular testing. On multivariable analysis, younger age (<45 years), failure to obtain an adequate erection during the original DUS, and having <2 vascular risk factors were predictive of a false diagnosis of venous leak.

CONCLUSIONS:

Penile DUS has a propensity to inaccurately assign a diagnosis of venous leak. Great care should be taken when performing DUS especially in younger men without a significant vascular risk factor history, and the failure to obtain a good erection should make the clinician cautious in assigning a diagnosis of venous leak. Furthermore, there still exists a role for cavernosometry, which appears to have a greater accuracy at diagnosing venous leak.

[Indexed for MEDLINE]

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