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Original Research

Open Access

The efficacy of penile duplex ultrasound in erectile dysfunction management decision-making: facing the opinion leader

  • Andrea Cocci1,*,
  • Marta Pezzoli1
  • Mattia Lo Re1
  • David Ralph2,3
  • Nim Christopher2,3
  • Daniar Osmonov4
  • Carlo Bettocchi5
  • Rados Djinovic6
  • Gabriele Antonini7
  • Laurence Levine8
  • Juan Ignacio Martínez Salamanca9
  • Javier Romero Otero10
  • Paulo Egydio11
  • Ignacio Moncada Iribarren12
  • Georgios Hatzichristodoulou13
  • Paul Perito14
  • Faix Antoine15
  • Hyun Jun Park16,17
  • Luigi Rolle18
  • Ateş Kadıoğlu19
  • Eduard Ruíz-Castañé20
  • Koenraad Van Renterghem21
  • Robert J Valenzuela22
  • Steven K Wilson23
  • Nuno Tomada24
  • Marco Capece25
  • Marco Falcone18

1University of human health sciences of Florence, 50134 Florence, Italy

2University College London Hospitals NHS Foundation Trust, NW1 2PG London, UK

3St. Peter’s Andrology Centre, W1G 6AA London, UK

4University Medical Center Schleswig-Holstein, 24105 Kiel, Germany

5University of Foggia, 71122 Foggia, Italy

6Center for Genito-Urinary Reconstructive Surgery, RF25+4V Belgrade, Serbia

7Antonini Urology, 00185 Rome, Italy

8Rush University Medical Center, Chicago, IL 60612, USA

9Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain

1012 de Octubre University Hospital, 28041 Madrid, Spain

11Egydio Medical Center, 04552-040 São Paulo, SP, Brazil

12Hospital Sanitas La Zarzuela, 28023 Madrid, Spain

13‘Martha-Maria’ Hospital Nuremberg, 90491 Nuremberg, Germany

14Perito Urology, Coral Gables, FL 33146, USA

15Clinique Saint-Roch, 34000 Montpellier, France

16Pusan National University School of Medicine, 49241 Busan, Republic of Korea

17Medical Research Institute of Pusan National University Hospital, 49241 Busan, Republic of Korea

18Molinette University Hospital, 10126 Turin, Italy

19Istanbul University İstanbul School of Medicine, 34093 İstanbul, Turkey

20Fundació Puigvert, 08025 Barcelona, Spain

21Jessa Ziekenhuis, 3500 Hasselt, Belgium

22The Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA

23Institute for Urologic Excellence, La Quinta, CA 92253, USA

24Hospital da Luz Arrábida, 4400-346 Porto, Portugal

25University of Naples Federico II, 80138 Naples, Italy

DOI: 10.22514/jomh.2024.084 Vol.20,Issue 6,June 2024 pp.8-11

Submitted: 28 December 2023 Accepted: 29 February 2024

Published: 30 June 2024

*Corresponding Author(s): Andrea Cocci E-mail:


Erectile dysfunction (ED) poses a significant challenge in clinical practice, necessitating accurate diagnostic strategies to distinguish between organic and psychogenic causes. Current guidelines advocate a comprehensive approach involving medical history, physical examination and blood tests, with second-level analyses like the intracavernous injection of vasoactive drugs (ICI test) and penile duplex ultrasound (PDU) reserved for specific cases. A survey involving 24 urologists experienced in ED was conducted to assess their opinions on the appropriateness of the ICI test and PDU in six clinical scenarios. Results were analyzed using pie charts, revealing varied preferences among experts. The responses indicated diverse viewpoints, with preferences for the ICI test or PDU depending on the patient’s age, comorbidities, response to phosphodiesterase type 5 inhibitors (PDE5i) and concomitant Peyronie’s disease. In some cases, a significant proportion of experts opted for neither test. The study highlights the lack of consensus among experts regarding the routine use of PDU in ED management. Despite its diagnostic capabilities, the clinical utility of PDU remains unclear, and its role may be more justified in certain populations with anatomical abnormalities or specific conditions. The need for rigorous research to determine the impact of PDU on ED management decision-making is emphasized.


Erectile dysfunction; Penile duplex ultrasound; Intracavernous injection

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Andrea Cocci,Marta Pezzoli,Mattia Lo Re,David Ralph,Nim Christopher,Daniar Osmonov,Carlo Bettocchi,Rados Djinovic,Gabriele Antonini,Laurence Levine,Juan Ignacio Martínez Salamanca,Javier Romero Otero,Paulo Egydio,Ignacio Moncada Iribarren,Georgios Hatzichristodoulou,Paul Perito,Faix Antoine,Hyun Jun Park,Luigi Rolle,Ateş Kadıoğlu,Eduard Ruíz-Castañé,Koenraad Van Renterghem,Robert J Valenzuela,Steven K Wilson,Nuno Tomada,Marco Capece,Marco Falcone. The efficacy of penile duplex ultrasound in erectile dysfunction management decision-making: facing the opinion leader. Journal of Men's Health. 2024. 20(6);8-11.


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