The Application Of Penile Doppler Ultrasound Assisting By Oral Sildenafil Combined Penile Cavernosal Injection Of Alprostadil In The Diagnosis Of Vascular Erectile Dysfunction

Purpose: The present study was intended to explore the application of oral sildenafil administration plus alprostadil injection to induce penile erection during penile doppler ultrasound（PDU）to diagnose the vascular erectile dysfunction（ED）.PDU examination was considered to be the “gold standard” for diagnosing vascular ED.However,the optimal erectile response might be limited because of an increased sympathetic discharge,which resulted from the fear of injection and anxiety of patients.Importantly,the diagnostic accuracy of PDU was influenced by the degree of the penile erection.We put forward the novel strategy that oral sildenafil administration plus alprostadil injection to induce penile erection during PDU examination.The positive results would improve the degree of penile erection during PDU examination,and the diagnostic accuracy of PDU examination.Most importantly,it could expand the clinical implication of PDU examination in diagnosis of vascular ED.Methods: We randomly selected a total of 60 ED patients referred to the clinical department of Urology and Andrology from September 2019 to November 2021,all the patient met the pre-defined inclusion criteria.Then,the patients were divided into two groups randomly,each group owning 30 patients equally.All patients would undergo PDU tests twice with different test order.The approaches assisting the PDU included two models to induce penile erection,mode A meaning injection of 15μg alprostadil and model B meaning oral sildenafil 100 mg plus injection of 15μg alprostadil.The PDU order of group 1 was from model A to model B,and from model B to model A for group 2,to minimize the sequential bias of being examined under different conditions.The PDU parameters were measured continuously including peak systolic velocity（PSV）,end diastolic velocity（EDV）,and resistive index（RI）.Also,the diagnostic classifications of vascular ED were recorded simultaneously.These recoded results were compared to explore the efficacy of the two assisted approached to induce penile erection during PDU test.Results: Eventually,a total of 60 eligible ED patients were enrolled in our study to be conducted PDU test twice.The mean age of study population was 40.77±6.73 years,and the mean IIEF-5 score in study population was 13.42±3.53.The baseline characteristics between the two groups were similar with no obviously statistical differences.During model A assisting PDU,the PSV,EDV,and RI were 37.87±13.37cm/s,3.31±4.79cm/s,and 0.89±0.13 respectively.For model B,the PSV,EDV,and RI were 45.56±15.79 cm/s,1.52±5.46cm/s,and 0.95±0.11 respectively.There were statistically significant increases of PDU parameters between model A and model B,with the P values<0.001.But the session orders didn’t have independent effect on PDU parameters,with no obviously statistical differences.For model A,the number of patients that were diagnosed as AED,VED,and Mix-ED,was 19（31.67%）,14（23.33%）,and 14（23.33%）respectively.While under model B,the number was changed to 9（15.00%）,23（38.33%）,and 5（8.33%）.Detailly,the distribution of AED between two models was statistically different with the P value as 0.031.Similarly,the distribution of Mix-ED also showed significant difference with the P values as 0.024.Apart from the two subtypes,the distribution of VED and nonvascular ED didn’t show obvious differences,and the P value was 0.075 and 0.066 respectively.Conclusions: Oral sildenafil administration plus alprostadil injection could improve the diagnostic accuracy of PDU by achieving the optimal penile erection,not only increasing the hemodynamic parameters,but also change the final subtypes diagnoses of vascular ED.Furtherly,more e large sample studies should be conducted to very our conclusion and expanding the clinical application of PDU test in ED patients.