Introduction: The cause of erectile dysfunction (ED) is not well defined for young men. Historically, vascular dysfunction was thought to be less prevalent in this age group. However, recent studies show that as many as 87% of young men presenting with ED have an underlying organic component. Penile duplex ultrasound (PDU) has become a popular procedure used to aid in diagnosing the etiology of ED. Addition of sonoelastography can be utilized to assess elasticity of penile tissue. This study evaluates the use of PDU in young men with ED.
Methods: After IRB approval, a retrospective chart review was performed examining patients less than 40 years old with ED who underwent PDU with injection of a vasoactive agent between January 2018 and June 2021. Patients who underwent ultrasound for other reasons, such as Peyronie’s disease, were excluded. Young men with ED only underwent PDU at our institution if ED was unresponsive to phosphodiesterase type 5-inhibitors (PDE-5 inhibitors).
Results: A total of 48 men less than 40 years of age with ED underwent PDU during the time frame of this study, with 32 men (66.7%) meeting the criteria for inclusion (mean age 30.5 years).
Only one patient in the entire cohort had zero evidence of vascular compromise on PDU. Thirty out of 32 patients (93.7%) exhibited some degree of arterial insufficiency. 10 (33%) patients had borderline insufficiency and 20 had severe insufficiency, in at least one corpora. Twelve (40%) of these patients with arterial insufficiency also displayed some evidence of venous leak, with an average end diastolic velocity of 6.3 ± 1.6 cm/sec.
Twelve patients underwent sonoelastography of the penis during PDU. Elasticity was measured in kilopascal (kPa). Elasticity in normal corpora cavernosa was 16.4 KPa and 15.3 KPa in the right and left corpora, respectively. Six out of 12 of these patients were noted to have increased firmness of the corpora bilaterally with a mean of 65.8 KPa and 76.0 KPa in the right and left corpora, respectively.
Conclusions: This study is one of the first to characterize PDU findings in young men with ED. 70% of these patients showed evidence of severe arteriogenic insufficiency, with a large majority of patients showing at least some degree of vascular dysfunction. This highlights the need for PDU in the evaluation of young men presenting with ED refractory to PDE-5 inhibitors. Half of men in which elastography was performed were found to have bilateral corporal firmness. Although the significance of this finding is not yet known, it suggests an intracorporal process that may contribute to ED in these young men and requires further investigation.
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