Evaluating the feasibility of a new non-invasive technique for improved diagnostics in vascular erectile dysfunction using an ultra-high-resolution ultrasound probe and venous compression: a proof of concept study.

Introduction
Erectile dysfunction (ED) is a clinically relevant condition, particularly among older men, with vascular causes such as venous leakage and arterial insufficiency being primary contributors.
Aim
This study aimed to assess the diagnostic accuracy of a novel, non-invasive approach employing ultrasound-guided venous compression to identify the primary vascular etiology in patients with ED.
Methods
A proof-of-concept study was conducted involving 40 male patients with confirmed ED. High-resolution Dynamic Duplex Sonography (DSU) was performed following intracavernosal injection of alprostadil to assess penile blood flow dynamics, including peak systolic velocity (PSV) and end-diastolic velocity (EDV). In 17 patients, a compression ring was individually selected using ultrasound and applied to restrict venous outflow while maintaining arterial inflow. PSV and EDV values were compared between standard DSU and venous compression + DSU (VC-DSU) with an individual selected compression ring. In addition, diagnostic accuracy was validated against CT-arteriography and CT-cavernosography in 10 patients.
Main Outcomes Measures
The primary outcome was an improvement in diagnostic accuracy of VC-DSU compared to standard DSU.
Results
VC-DSU significantly improved detection of the primary vascular cause in ED, with an accuracy of 90% versus 20% for DSU. Under venous compression, changes in PSV served as key diagnostic markers: a marked increase indicated a venous origin, while stable or varied PSV values distinguished arterial or mixed causes. The accuracy of VC-DSU was comparable to CT cavernosography (P = 0.096), highlighting its potential as a reliable non-invasive alternative.
Clinical Implications
VC-DSU offers a non-invasive method to assess vascular contributions to erectile dysfunction with promising diagnostic potential to more accurately identify the vascular cause.
Strengths And Limitations
Key strengths of this study include its innovative, non-invasive approach and its direct comparison to cavernosography. However, the limited sample size restricts the generalizability of findings, highlighting the need for larger-scale trials to validate these results. Additionally, patient allocation to VC-DSU and cavernosography was based on willingness to participate rather than a predefined protocol, introducing a potential selection bias.
Conclusion
VC-DSU represents a promising non-invasive and accurate tool that complements traditional diagnostic methods for vascular ED, particularly by enhancing the differentiation of the predominant vascular etiology.