Low utilization of intracavernosal injection and penile Doppler ultrasound in the evaluation of erectile dysfunction and Peyronie's disease.

INTRODUCTION

Despite the diagnostic value of intracavernosal injections (ICI) and penile Doppler ultrasound (PDUS), there remain barriers to widespread clinical adaptation of these methods. The study aimed to evaluate the practice patterns of utilization of ICI and PDUS in the assessment of erectile dysfunction (ED) and Peyronie's disease (PD).

METHODS

Using the TriNetX database (Cambridge, MA, USA), adult (≥18 years) male patients with a diagnosis of ED on oral phosphodiesterase-5 (PDE5) inhibitors were identified. Current Procedural Terminology codes were utilized to identify patients who underwent further evaluation with ICI or PDUS, as well as penile prosthesis placement after PDUS. A second cohort was analyzed, identifying patients with a diagnosis of PD who underwent ICI or PDUS, and those who subsequently underwent PD treatment.

RESULTS

Among 104 healthcare organizations, 52,227,262 adult males were screened for ED and PD. 1,689,907 (3.2%) patients had ED and 66,390 (0.1%) patients had PD. Among ED patients, there were 6508 (0.4%) who subsequently went on to receive penile prosthesis. Amongst ED patients, only 23,836 (1.4%) and 8548 (0.5%) patients underwent workup with ICI or PDUS. The number of patients who subsequently received a prosthesis after ICI and PDUS workup was 4680 (19.6%) and 868 (10.1%), respectively. Amongst PD patients, 2960 (4.5%) and 4972 (7.4%) underwent workup with ICI and PDUS, respectively.

CONCLUSION

We recognize that ED and PD are challenging disease processes with complicated diagnostic workup involved. We recommend that providers be knowledgeable about counseling patients and even consider referring motivated patients to high-volume referral centers for definitive treatment.