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Gray-scale ultrasound to assess persistent erectile dysfunction in young men

Goldstein, I1; Rubin, RS2; Winter, AG2; Bertolotto, M3

1: Alvarado Hospital, United States; 2: San Diego Sexual Medicine, USA; 3: University of Trieste, Italy

Objectives: Young men exposed to 5 alpha reductase inhibitor (5ARI) finasteride for androgenic alopecia have reported persistent erectile dysfunction (PED). We are unaware of studies assessing their PED pathophysiology. Animals exposed to 5ARI have revealed both prostate smooth muscle and penile smooth muscle cell atrophy and apoptosis. High resolution gray-scale ultrasound (GSU) imaging is an efficient, non-invasive technique to assess cavernosal erectile tissue fibrosis (CETF) in men with ED. In selected men with PED from finasteride, high resolution GSU during maximal pharmacologic smooth muscle relaxation was used to better understand the pathophysiology. A renowned penile ultrasound expert (MB) blindly reviewed high resolution GSU images.

Material and Methods: Under IRB approval, charts of 27 men with PED (mean age 31) met inclusion/exclu-sion: potent prior to finasteride use; <40 years old with no obvious cardiovascular risk factors; underwent high resolution GSU/color duplex Doppler ultrasound with a high frequency probe (Aixplorer 15.4 MHz transducer) during maximal pharmacologic erection. GSU was performed in axial B-mode at multiple gains, with various dynamic ranges, in multiple penile shaft locations, to determine presence/absence of erectile tissue homogeneity or observation of heterogeneous regions. Color Doppler parameters of peak systolic velocity (PSV) and end-diastolic velocity (EDV) were also assessed. Ten control subjects with ED not exposed to finasteride who had erectile tissue homogeneity on high resolution GSU were also reviewed blindly by the ultrasound expert.

Results: Mean use of finasteride among the PED patients was 3.5 years. EF domain scores averaged 14/30. GSU images (27 PED patients, 10 controls) were blindly reviewed by the ultrasound expert. 28 identical assessments were found regarding extent of fibrosis (75.7%). The weighted kappa (degree of agreement between 2 raters) between the GSU assessments was 0.657, considered to be 'moderate to substantial' agreement. 96% demonstrated lack of homogeneity and hyperechoic/hypoechoic regions in erectile tissue.

Conclusions: In the largest series of men with PED after finasteride use who underwent high resolution GSU assessments, lack of homogeneity was noted in most, confirmed by independent ultrasound expert review. In men with PED, high resolution gray-scale ultrasound imaging is an efficient and non-invasive technique to assess cavernosal tissue fibrosis.


Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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