Comparison of penile doppler ultrasound versus Erection Hardness Score during intracavernous injection test in predicting refractory erectile dysfunction

Abstract Our group has shown that intracavernous injection test (ICI) have a better accuracy in predicting short-term response to therapy with sildenafil citrate versus penile doppler ultrasound (PDU). Our objective was to compare the prognostic value of PDU parameters with erection rigidity assessed by the Erection Hardness Score (EHS) during ICI in predicting refractory ED after 5-years. Patients referred for ED were evaluated and had a PDU with, at least, 15 ug of intracavernous alprostadil. Refractory ED was defined as having a penile prosthesis implanted, failed non-surgical treatments but refused penile prosthesis (PP) implantation or discontinuation of non-surgical treatments due to loss of efficacy. Receiver operating characteristic curves were drawn and the area under the curve (AUC) was calculated. At 5 years, 69 men were still in follow-up with a mean age of 58.47 years and 13 (18.8%) were classified as having refractory ED. The AUC for EHS, peak systolic velocity, end diastolic flow and resistive index to discriminate refractory ED were 0.820, 0.613, 0.730 and 0.714, respectively. Our data suggest that an abnormal EHS during an ICI could be non-inferior than an abnormal PDU in predicting response to non-surgical treatments and that will need a PP in long-term.