The journal of sexual medicine · 2026
A novel non-invasive diagnostic marker for arterial erectile dysfunction: cavernosal artery ondulation index measured in the flaccid phase.
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Tuzcu Göksel, Ateş Erhan, Alkaşi Ali, Varol Aral, Özsoy Çağatay, Gök Mustafa
Аннотация
BACKGROUND: Arteriogenic insufficiency (AI) is the most common vascular cause of erectile dysfunction (ED) and is traditionally diagnosed using semi-invasive papaverine-induced penile Doppler ultrasonography (P-PDUS).
AIM: To evaluate the feasibility and diagnostic accuracy of the cavernosal artery ondulation index (CA-OI) measured during the flaccid penile phase for identifying AI in men with ED.
METHODS: This prospective study included 90 men with clinically confirmed ED (International Index of Erectile Function-5 ≤ 25) and suspected vascular etiology. Gray-scale and color Doppler ultrasonography were performed in the flaccid state to measure CA-OI. AI was diagnosed according to established P-PDUS criteria, and patients were classified into AI (n = 28) and non-AI (n = 62) groups. CA-OI values were compared between groups, and receiver operating characteristic curve analysis was used to evaluate diagnostic performance.
OUTCOMES: The primary outcome was the diagnostic accuracy of flaccid-phase CA-OI for detecting AI.
RESULTS: Patients with AI were significantly older than those without AI (59.8 ± 8.8 vs. 46.4 ± 13.5 years, P < .001) and had a higher prevalence of diabetes mellitus (P < .001). Mean CA-OI values were significantly higher in the AI group (2.76 ± 0.28 vs. 2.33 ± 0.17, P < .001). Receiver operating characteristic analysis demonstrated excellent diagnostic performance, with an area under the curve of 0.906. A CA-OI cut-off value of 2.46 yielded 89.3% sensitivity and 79% specificity for identifying AI.
CLINICAL IMPLICATIONS: Measurement of CA-OI in the flaccid phase offers a non-invasive and clinically practical approach for the initial screening of arteriogenic ED, potentially reducing the need for intracavernosal injection.
STRENGTHS AND LIMITATIONS: The principal strength of this study is the first evaluation of CA-OI as a non-invasive diagnostic marker obtained during the flaccid penile phase; limitations include the single-center design and the use of P-PDUS rather than angiography as the reference standard.
CONCLUSION: CA-OI measured during the flaccid penile phase is a highly accurate, non-invasive marker for AI in men with ED.
AIM: To evaluate the feasibility and diagnostic accuracy of the cavernosal artery ondulation index (CA-OI) measured during the flaccid penile phase for identifying AI in men with ED.
METHODS: This prospective study included 90 men with clinically confirmed ED (International Index of Erectile Function-5 ≤ 25) and suspected vascular etiology. Gray-scale and color Doppler ultrasonography were performed in the flaccid state to measure CA-OI. AI was diagnosed according to established P-PDUS criteria, and patients were classified into AI (n = 28) and non-AI (n = 62) groups. CA-OI values were compared between groups, and receiver operating characteristic curve analysis was used to evaluate diagnostic performance.
OUTCOMES: The primary outcome was the diagnostic accuracy of flaccid-phase CA-OI for detecting AI.
RESULTS: Patients with AI were significantly older than those without AI (59.8 ± 8.8 vs. 46.4 ± 13.5 years, P < .001) and had a higher prevalence of diabetes mellitus (P < .001). Mean CA-OI values were significantly higher in the AI group (2.76 ± 0.28 vs. 2.33 ± 0.17, P < .001). Receiver operating characteristic analysis demonstrated excellent diagnostic performance, with an area under the curve of 0.906. A CA-OI cut-off value of 2.46 yielded 89.3% sensitivity and 79% specificity for identifying AI.
CLINICAL IMPLICATIONS: Measurement of CA-OI in the flaccid phase offers a non-invasive and clinically practical approach for the initial screening of arteriogenic ED, potentially reducing the need for intracavernosal injection.
STRENGTHS AND LIMITATIONS: The principal strength of this study is the first evaluation of CA-OI as a non-invasive diagnostic marker obtained during the flaccid penile phase; limitations include the single-center design and the use of P-PDUS rather than angiography as the reference standard.
CONCLUSION: CA-OI measured during the flaccid penile phase is a highly accurate, non-invasive marker for AI in men with ED.