Erectile dysfunction secondary to venous incompetence

Case contributed by Shahmeer Khan
Diagnosis almost certain


History of childhood trauma and bladder repair, now presented with erectile dysfunction.

Patient Data

Age: 30 years
Gender: Male

Preliminary greyscale sonogram did not reveal any structural anomaly or plaque.

Baseline central cavernosal artery peak systolic velocity reached 6.3 cm/sec on left side, while pulsatile flow was noted on right side.

Subsequently 60 mg of TriMix (lypophylised mixture of papaverine, phentolamine mesylate, and prostaglandin E1) was injected intracavernosally. Post-injection images were acquired. A characteristic dichrotic notch waveform pattern with a peak systolic velocity of 58.5 cm/sec noted on left side at 25 minutes post-injection, however, with persistent venous flow. Persistent venous flow with peak systolic velocity of 16.5 cm/s observed on right side 25 minutes post-injection. Persistent venous flow noted bilaterally.

Case Discussion

After performing a greyscale sonographic examination and injecting TriMix injection under ultrasound guidance, images were obtained at intervals of 5 minutes for a total of 25 minutes.

Findings are consistent with tumescence phase of erection on the left side and arterial insufficiency on the right side with persistent venous flow representing penile venous incompetence. 

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