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Penile Doppler Ultrasound & Cavernosometry

Penile Doppler ultrasound (PDUS) is the primary minimally invasive imaging modality for evaluating penile hemodynamics, used to differentiate arteriogenic, venogenic, and mixed vasculogenic erectile dysfunction (ED), as well as to assess Peyronie disease plaques, penile fracture, and priapism.[1][2] Dynamic infusion cavernosometry and cavernosography (DICC) remains the gold standard for diagnosing veno-occlusive dysfunction (VOD), though its use has declined as surgical venous ligation has fallen out of favor.[3][4]

For the broader ultrasound primer (sonourethrogram, renal US, pelvic floor US), see Ultrasound in Reconstructive Urology. For the clinical conditions evaluated by these tests, see Erectile Dysfunction and the PDE5 inhibitor, intracavernosal injection agent, and priapism management hubs.

Physiology of Erection — Basis for Hemodynamic Testing​

Normal erection involves three hemodynamic phases that produce characteristic Doppler waveform changes:[5]

  1. Arterial inflow phase — cavernosal artery dilation → increased peak systolic velocity (PSV), high diastolic flow.
  2. Tumescence phase — expanding sinusoids compress subtunical venules → progressive decrease in end-diastolic velocity (EDV).
  3. Full erection / rigid phase — complete veno-occlusion → EDV approaches zero or becomes negative (reversed diastolic flow); resistive index (RI) approaches 1.0.

Failure at any phase produces a specific hemodynamic signature detectable by Doppler.[5][6]

Penile Doppler Ultrasound (PDUS)​

Indications​

  • ED refractory to PDE5 inhibitors (to differentiate arteriogenic vs venogenic vs psychogenic).[1][7]
  • Pre-surgical evaluation for Peyronie disease (plaque characterization, calcification, vascular integrity).[8][9]
  • Penile fracture with equivocal clinical findings.[10]
  • Priapism — differentiation of ischemic vs non-ischemic subtypes; localization of arteriovenous fistulae.[11][12]
  • Post-revascularization follow-up.[2]
  • Young men with post-traumatic ED being considered for penile revascularization.[13]

Equipment and Setup​

  • High-frequency linear transducer (7.5–15 MHz).[2][6]
  • Patient supine or in lithotomy position.
  • Gray-scale, color Doppler, and spectral (pulsed-wave) Doppler modes.
  • Private, comfortable environment to minimize anxiety-related sympathetic tone, which impairs smooth muscle relaxation and produces false-positive results.[1]

Vasoactive Agents and Dosing Protocols​

Pharmacologic induction of erection is essential — the accuracy of PDUS is entirely predicated on achieving complete cavernosal smooth muscle relaxation.[1]

AgentDoseNotes
Alprostadil (PGE1)10–20 µg ICI (start 10 µg)Only FDA-approved agent for diagnostic ICI; preferred for PDUS[1][14][16]
Trimix (PGE1 + papaverine + phentolamine)e.g., PGE1 10 µg + papaverine 30 mg + phentolamine 0.5 mgHigher potency; used when alprostadil alone insufficient[7]
Papaverine12.5–60 mgHistorical agent; higher priapism risk; not FDA-approved for ICI[15]
Papaverine + phentolamine60 mg + 1 mgClassic combination; used in early DICC studies[17]

Redosing protocol — if the initial injection does not produce a fully rigid erection, a second dose (typically half the initial dose) is administered after 10–15 minutes. The study is only valid when maximum smooth muscle relaxation is achieved — either full rigidity or maximum vasoactive dose.[1] Visual sexual stimulation (VSS) may be added to augment the pharmacologic response.[18]

Technique — Step by Step​

  1. Baseline scan — gray-scale assessment of penile anatomy (cavernosal artery diameter, normal ~0.3–0.5 mm flaccid; tunica albuginea, septum, plaques, structural abnormalities).[2][6]
  2. Intracavernosal injection (ICI) — inject vasoactive agent into the lateral aspect of one corpus cavernosum at the mid-shaft using a 27–30 gauge needle.[14]
  3. Serial Doppler measurements — begin scanning 5 minutes post-injection and repeat at 5-minute intervals for 20–30 minutes. Measure bilaterally at a standardized location.[1][6]
  4. Doppler parameters recorded:
    • Peak systolic velocity (PSV) at peak systole.
    • End-diastolic velocity (EDV) at end-diastole.
    • Resistive index (RI) = (PSV − EDV) / PSV.
    • Acceleration time — time from onset of systole to peak systole.
    • Cavernosal artery diameter change (pre- and post-injection).
  5. Angle correction — Doppler angle should be ≤ 60° for accurate velocity measurements.[6]
  6. Post-procedure monitoring — assess for detumescence. If persistent rigid erection > 1 hour, administer intracavernosal phenylephrine (100–500 µg diluted, repeated every 5–10 minutes); if refractory, perform corporal aspiration.[1]

Sampling Location — A Critical Variable​

The anatomic site of Doppler interrogation significantly affects measured values and can alter the diagnosis:[19][20]

  • PSV is highest at the crura (52.9 ± 20.2 cm/s) and decreases distally to the mid-penis (21.6 ± 10.6 cm/s; p < 0.001).[20]
  • EDV does not vary significantly by location.[20]
  • Arteriogenic ED is better diagnosed at the mid-penis, while non-arteriogenic ED is better diagnosed at the crura.[19]
  • Current guidelines do not specify a standard location, which is a recognized limitation.[20]

Interpretation — Normal Values and Diagnostic Criteria​

ParameterNormalAbnormalInterpretation
PSV> 30 cm/s (some use > 35 cm/s)< 25 cm/s = definite arterial insufficiency; 25–30 cm/s = borderlineCavernosal arterial inflow
EDV< 5 cm/s> 5 cm/s = veno-occlusive dysfunctionVenous outflow / veno-occlusive mechanism
RI> 0.90 (in full erection)< 0.75–0.80 = venous leakComposite measure; RI = (PSV − EDV) / PSV
Acceleration time< 110 ms> 110 ms = arterial diseaseTime to peak systole; sensitive for proximal arterial stenosis
Cavernosal artery diameter> 0.7 mm post-injection< 0.7 mmLess reliable than velocity parameters

Sources: [1][5][6][18][21][22][23][24]

Diagnostic Categories Based on PDUS[1][6][13]​

  • Normal hemodynamics — PSV > 30 cm/s, EDV < 5 cm/s, RI > 0.90.
  • Psychogenic / neurogenic ED — hemodynamics are typically normal; failure to achieve rigidity reflects sympathetic tone or impaired neural input rather than vascular disease.
  • Arteriogenic ED — PSV < 30 cm/s.
  • Venogenic / VOD — PSV ≥ 30 cm/s with EDV > 5 cm/s and/or RI < 0.75.
  • Mixed — PSV < 30 cm/s with EDV > 5 cm/s and/or RI < 0.75.
  • Combined cavernosal artery insufficiency + VOD was the most common pattern (58.9% of patients) in a large multi-institutional DICC study.[13]

Age-related normative data — in 259 men without organic ED (mean age 53.7), normal parameters were PSV > 35 cm/s and RI > 0.90. A significant age-related decline in post-VSS PSV was observed (p = 0.005), but RI remained preserved across age groups, suggesting that arterial inflow declines with age while veno-occlusive function is maintained.[18]

Diagnostic Accuracy of PDUS for Venous Leak​

When compared against cavernosography as the reference standard, the most accurate PDUS criterion for venous ED uses a combination of: continuous deep dorsal vein flow with peak velocity > 3 cm/s, PSV > 30 cm/s, and EDV > 5 cm/s — yielding sensitivity 91.7%, specificity 70.6%, and accuracy 84.9%.[21] Adding RI < 0.75 to these criteria further improves specificity.[21]

A novel venous compression technique (VC-DSU) using an individually selected compression ring during Doppler assessment improved diagnostic accuracy to 90% (vs 20% for standard DSU), comparable to CT cavernosography (p = 0.096).[25]

PDUS in Peyronie Disease​

The AUA Peyronie Disease Guideline recommends an in-office ICI test with or without duplex Doppler ultrasound prior to invasive intervention.[8] PDUS provides:[9][26][27]

  • Plaque characterization — location, size, number, and calcification status (calcified plaques respond poorly to intralesional therapy).
  • Vascular assessment — up to 55–61% of men with Peyronie disease and ED on questionnaires have normal vascular parameters on PDUS, suggesting their ED is mechanical / psychological rather than vasculogenic.[28]
  • Septal fibrosis and intracavernosal fibrosis — strongly correlated with difficulty maintaining erection.[27]
  • Surgical planning — helps determine whether plication, grafting, or penile prosthesis is most appropriate.[26]

PDUS in Priapism​

Color Doppler ultrasound is invaluable for differentiating priapism subtypes when clinical assessment and blood gas analysis are equivocal:[11][12][29]

  • Ischemic priapism — absent or severely diminished cavernosal artery flow; low / absent PSV; no diastolic flow.
  • Non-ischemic priapism — normal to high cavernosal artery velocities; turbulent flow at the site of arteriovenous fistula; color aliasing.
  • Fistula localization — PDUS identifies the location and size of arterio-lacunar fistulae, guiding selective embolization planning.[11]

The AUA / SMSNA Priapism Guideline recommends PDUS for assessment of fistula location and size in non-ischemic priapism, and notes it can be performed non-urgently.[11]

A novel STIFF protocol (Sonography to Identify Forward Flow) has been proposed for emergency department use, involving controlled glans compression during continuous Doppler monitoring to dynamically assess cavernosal flow and predict response to aspiration alone.[30]

PDUS in Penile Fracture​

The AUA Urotrauma Guideline states that ultrasound may be performed in patients with equivocal signs and symptoms of penile fracture (Grade C recommendation).[10] Ultrasound can:[10][31]

  • Identify tunica albuginea disruption (discontinuity of the hyperechoic tunica).
  • Differentiate intracavernosal from extracavernosal hematomas.

Routine ultrasound is not necessary when the diagnosis is clinically clear; MRI is an alternative when US is equivocal or unavailable.[10]

Dynamic Infusion Cavernosometry and Cavernosography (DICC)​

Overview​

DICC is the gold standard for diagnosing veno-occlusive dysfunction, providing both functional (pressure-based) and anatomic (radiographic) assessment of the corporeal veno-occlusive mechanism.[3][4] However, its use has declined substantially as venous ligation surgery has demonstrated poor long-term outcomes.[4][32]

Technique[4][13][17]​

DICC is performed in four phases:

Phase I — Pharmacologic Equilibrium Pressure​

  • Two needles (19-gauge butterfly) are placed in the corpora cavernosa — one for infusion, one for pressure monitoring.
  • Vasoactive agent is injected (papaverine 60 mg + phentolamine 1 mg, or alprostadil 20 µg).
  • Wait 10–20 minutes for maximum smooth muscle relaxation.
  • Record the equilibrium intracorporeal pressure (EIP) — the maximum pressure achieved without infusion.
  • Normal EIP approaches mean arterial pressure (~80–100 mmHg); in the multi-institutional study, mean EIP was only 29.4 mmHg, reflecting the high prevalence of vascular disease.[13]

Phase II — Cavernosometry (Flow-to-Maintain and Pressure Decay)​

  • Heparinized saline is infused via roller pump to raise intracorporeal pressure to 150 mmHg, then the pump is stopped.
  • Pressure decay (PD) — drop in pressure over 30 seconds from 150 mmHg. Normal: < 45 mmHg; greater drop indicates VOD.[4][13]
  • Alternatively, flow-to-maintain (FTM) — the infusion rate required to maintain intracorporeal pressure at 90–100 mmHg. Normal < 3 mL/min; values 3–5 mL/min suggest mild venous leak; > 20 mL/min indicates severe VOD.[4][32]
  • Resistance = pressure / flow; normal > 5 (mmHg·min)/mL.[33]

Phase III — Cavernosal Artery Occlusion Pressure (Optional)​

  • Measures the gradient between systemic systolic pressure and cavernosal artery pressure.
  • Assesses arterial inflow adequacy.
  • Mean gradient was 42–43 mmHg in the multi-institutional study.[13]

Phase IV — Cavernosography​

  • Diluted contrast medium is infused while maintaining intracorporeal pressure at 90 mmHg.
  • Fluoroscopic images are obtained to identify the sites of venous leakage:
    • Deep dorsal vein system (most common).
    • Cavernosal (crural) veins.
    • Spongiosal system.
    • Combined patterns.[17][34]

Severity Classification by DICC[3]​

  • Non-VED — FTM < 3 mL/min.
  • Mild VED — FTM 3–15 mL/min.
  • Moderate VED — FTM 15–50 mL/min.
  • Severe VED — FTM > 50 mL/min.

Limitations of DICC[4][32]​

  • Invasive — requires corporal puncture, contrast injection, and fluoroscopy.
  • False positives — incomplete smooth muscle relaxation is the most common cause of false-positive results.[4][35]
  • Cavernosography adds limited value — 46% of men with abnormal FTM values had a normal cavernosogram, undermining the utility of the radiographic component, particularly in low-grade venous leak.[32]
  • Declining clinical relevance — as venous ligation surgery has fallen out of favor due to poor long-term outcomes, the anatomic information from cavernosography is less actionable.[32][36]

Gravity Cavernosometry​

A simplified alternative using an infusion set (gravity-driven) rather than a roller pump. Diagnostic value is comparable to pump cavernosometry, with advantages of simplicity, lower cost, and fewer complications. Maintenance flow remains the most accurate parameter.[35]

Pudendal Arteriography​

Selective internal pudendal arteriography is the definitive test for arterial anatomy and is reserved for young men with post-traumatic ED being considered for penile revascularization surgery.[13][23] In the multi-institutional DICC study, 169 patients underwent arteriography, and 105 proceeded to arterial bypass surgery.[13] It is not used as a screening tool due to its invasiveness.

Advanced Imaging Modalities​

ModalityRoleAdvantagesLimitations
CT cavernosographyVenous leak mapping; validation of PDUS findings3D anatomic detail; identifies venous drainage patternsRadiation; contrast; invasive
CT angiographyPudendal artery anatomy for embolization planning (NIP)Vascular roadmapRadiation; contrast
MRIPenile fracture (equivocal US); tumor staging; cavernosal necrosis in ischemic priapismSuperior soft-tissue contrast; no radiationCost; availability; limited hemodynamic data
Time-resolved MRAArteriovenous shunting; venous leak localizationTemporal + spatial resolution; 85.2% concordance with PDUSRequires contrast + ICI; limited availability
Penile angiographyPre-revascularization arterial mapping; therapeutic embolization (NIP)Gold standard for arterial anatomy; therapeutic capabilityInvasive; radiation; contrast

Sources: [12][13][25][37][38][39]

Ultrasound with color Doppler remains superior to MRI for evaluating vascular causes of ED, while MRI is better for tumor staging and detecting impalpable Peyronie plaques.[38]

PDUS as a Cardiovascular Risk Marker​

ED is increasingly recognized as an early manifestation of systemic vascular disease. A 2026 single-center retrospective study of 275 men found that impaired PSV (< 30 cm/s) was associated with elevated cardiovascular risk profile, supporting the role of PDUS as an early sentinel test for occult atherosclerosis in men presenting with ED.[40]

Practical Pearls and Pitfalls​

  • Incomplete smooth muscle relaxation is the single most common cause of false-positive results on both PDUS and DICC — always use a redosing protocol and consider VSS.[1][4][35]
  • Anxiety-mediated sympathetic tone can produce falsely low PSV and falsely elevated EDV — a private, comfortable environment is essential.[1]
  • Sampling location matters — PSV varies by > 30 cm/s between crura and mid-penis; future guidelines should standardize the measurement site.[20]
  • Asymmetric cavernosal artery flow (significant PSV difference between right and left) suggests unilateral arterial disease.[24]
  • Dorsal vein flow on Doppler can suggest venous leak, but cavernosal venous leaks cannot be detected by Doppler alone — DICC remains necessary for definitive venous assessment.[41]
  • Peyronie patients — questionnaire-based ED assessment is often discordant with PDUS findings. 55–61% of men with "severe ED" on IIEF have normal vascular parameters, suggesting mechanical rather than vascular etiology.[28]

Summary of Diagnostic Algorithm​

  1. First-line — history, physical exam, validated questionnaires (IIEF-5), laboratory evaluation (testosterone, metabolic panel).
  2. Second-line — PDUS with ICI: differentiates arteriogenic, venogenic, mixed, and non-vascular ED; characterizes Peyronie plaques.
  3. Third-line (selected patients) — DICC: gold standard for VOD quantification; reserved for young men considering venous surgery or embolization.
  4. Fourth-line (rare) — Pudendal arteriography: pre-revascularization mapping in young post-traumatic ED patients.

The AUA ED Guideline does not mandate vascular testing for all men with ED, as most are managed empirically with PDE5 inhibitors, ICI, or penile prosthesis. Hemodynamic testing is most valuable when it will change management — particularly in young men with post-traumatic ED, Peyronie disease surgical planning, or refractory ED where the mechanism is unclear.[1][7]

References​

1. Flores JM, West M, Mulhall JP. "Efficient Use of Penile Doppler Ultrasound for Investigating Men With Erectile Dysfunction." J Sex Med. 2024;21(8):734–739. doi:10.1093/jsxmed/qdae070

2. Kho YY, Lee SHE, Chin K, et al. "US of the Penis: Beyond Erectile Dysfunction." Radiographics. 2024;44(6):e230157. doi:10.1148/rg.230157

3. Gao QQ, Chen JH, Chen Y, Song T, Dai YT. "Dynamic Infusion Cavernosometry and Cavernosography for Classifying Venous Erectile Dysfunction and Its Significance for Individual Treatment." Chin Med J. 2019;132(4):405–410. doi:10.1097/CM9.0000000000000099

4. Glina S, Ghanem H. "SOP: Corpus Cavernosum Assessment (Cavernosography / Cavernosometry)." J Sex Med. 2013;10(1):111–114. doi:10.1111/j.1743-6109.2012.02795.x

5. Meuleman EJ, Bemelmans BL, van Asten WN, et al. "Assessment of Penile Blood Flow by Duplex Ultrasonography in 44 Men With Normal Erectile Potency in Different Phases of Erection." J Urol. 1992;147(1):51–56. doi:10.1016/s0022-5347(17)37131-8

6. Varela CG, Yeguas LAM, Rodríguez IC, Vila MDD. "Penile Doppler Ultrasound for Erectile Dysfunction: Technique and Interpretation." AJR Am J Roentgenol. 2020;214(5):1112–1121. doi:10.2214/AJR.19.22141

7. Burnett AL, Nehra A, Breau RH, et al. "Erectile Dysfunction: AUA Guideline." J Urol. 2018;200(3):633–641. doi:10.1016/j.juro.2018.05.004

8. Nehra A, Alterowitz R, Culkin DJ, et al. "Peyronie's Disease: AUA Guideline." J Urol. 2015;194(3):745–753. doi:10.1016/j.juro.2015.05.098

9. McCauley JF, Dean RC. "Diagnostic Utility of Penile Ultrasound in Peyronie's Disease." World J Urol. 2020;38(2):263–268. doi:10.1007/s00345-019-02928-y

10. Morey AF, Broghammer JA, Hollowell CMP, McKibben MJ, Souter L. "Urotrauma Guideline 2020: AUA Guideline." J Urol. 2021;205(1):30–35. doi:10.1097/JU.0000000000001408

11. Bivalacqua TJ, Allen BK, Brock GB, et al. "The Diagnosis and Management of Recurrent Ischemic Priapism, Priapism in Sickle Cell Patients, and Non-Ischemic Priapism: An AUA / SMSNA Guideline." J Urol. 2022;208(1):43–52. doi:10.1097/JU.0000000000002767

12. von Stempel C, Walkden M, Kirkham A. "Review of the Role of Imaging in the Diagnosis of Priapism." Int J Impot Res. 2024. doi:10.1038/s41443-024-00928-0

13. Kaufman JM, Borges FD, Fitch WP, et al. "Evaluation of Erectile Dysfunction by Dynamic Infusion Cavernosometry and Cavernosography (DICC). Multi-Institutional Study." Urology. 1993;41(5):445–451. doi:10.1016/0090-4295(93)90505-5

14. U.S. Food and Drug Administration. "Caverject (Alprostadil) Prescribing Information." Updated 2024-05-13.

15. Meuleman EJ, Bemelmans BL, Doesburg WH, et al. "Penile Pharmacological Duplex Ultrasonography: A Dose-Effect Study Comparing Papaverine, Papaverine/Phentolamine and Prostaglandin E1." J Urol. 1992;148(1):63–66. doi:10.1016/s0022-5347(17)36511-4

16. Bassiem MA, Ismail IY, Salem TA, El-Sakka AI. "Effect of Intracavernosal Injection of Prostaglandin E1 on Duration and Rigidity of Erection in Patients With Vasculogenic Erectile Dysfunction: Is It Dose Dependent?" Urology. 2021;148:173–178. doi:10.1016/j.urology.2020.09.030

17. Bookstein JJ, Valji K, Parsons L, Kessler W. "Penile Pharmacocavernosography and Cavernosometry in the Evaluation of Impotence." J Urol. 1987;137(4):772–776. doi:10.1016/s0022-5347(17)44208-x

18. Pathak RA, Broderick GA. "Color Doppler Duplex Ultrasound Parameters in Men Without Organic Erectile Dysfunction." Urology. 2020;135:66–70. doi:10.1016/j.urology.2019.09.002

19. Pezzoni F, Scroppo FI, Cavallini G. "Differences in Cavernosal Artery Parameters According to Different Anatomic Sampling Locations During the Diagnosis of Vascular Erectile Dysfunction Using Duplex Ultrasound." Urology. 2017;105:33–41. doi:10.1016/j.urology.2017.01.057

20. Pagano MJ, Stahl PJ. "Variation in Penile Hemodynamics by Anatomic Location of Cavernosal Artery Imaging in Penile Duplex Doppler Ultrasound." J Sex Med. 2015;12(9):1911–1919. doi:10.1111/jsm.12958

21. Chen L, Xu L, Wang J, et al. "Diagnostic Accuracy of Different Criteria of Pharmaco-Penile Duplex Sonography for Venous Erectile Dysfunction." J Ultrasound Med. 2019;38(10):2739–2748. doi:10.1002/jum.14982

22. Bassiouny HS, Levine LA. "Penile Duplex Sonography in the Diagnosis of Venogenic Impotence." J Vasc Surg. 1991;13(1):75–82; discussion 82–83.

23. Valji K, Bookstein JJ. "Diagnosis of Arteriogenic Impotence: Efficacy of Duplex Sonography as a Screening Tool." AJR Am J Roentgenol. 1993;160(1):65–69. doi:10.2214/ajr.160.1.8416650

24. Benson CB, Vickers MA. "Sexual Impotence Caused by Vascular Disease: Diagnosis With Duplex Sonography." AJR Am J Roentgenol. 1989;153(6):1149–1153. doi:10.2214/ajr.153.6.1149

25. Gutwein A, Braun AJ, Thalhammer C, et al. "Evaluating the Feasibility of a New Non-Invasive Technique for Improved Diagnostics in Vascular Erectile Dysfunction Using an Ultra-High-Resolution Ultrasound Probe and Venous Compression: A Proof of Concept Study." J Sex Med. 2025;22(6):1024–1034. doi:10.1093/jsxmed/qdaf073

26. Pradeep A, Alexander LF, Padilla-Maldonado GW, et al. "Imaging Techniques for Diagnosing and Managing Peyronie Disease." Abdom Radiol. 2025;50(1):349–359. doi:10.1007/s00261-024-04521-3

27. Chung E, Yan H, De Young L, Brock GB. "Penile Doppler Sonographic and Clinical Characteristics in Peyronie's Disease and/or Erectile Dysfunction: An Analysis of 1500 Men With Male Sexual Dysfunction." BJU Int. 2012;110(8):1201–1205. doi:10.1111/j.1464-410X.2011.10851.x

28. Masterson TA, Efimenko IV, Nackeeran S, Parmar M, Ramasamy R. "Discordant Erectile Function Assessment Between Validated Questionnaire Scores and Penile Doppler Ultrasound in Peyronie's Disease." Int J Impot Res. 2022;34(5):452–455. doi:10.1038/s41443-021-00416-9

29. Pang KH, Alnajjar HM, Lal A, Muneer A. "An Update on Mechanisms and Treatment Options for Priapism." Nat Rev Urol. 2025. doi:10.1038/s41585-025-01069-9

30. Leamon A, Montoya K, Shokoohi H. "A Novel Approach to Priapism Doppler Assessment: Sonography to Identify Forward Flow (STIFF Protocol)." J Emerg Med. 2025;78:33–36. doi:10.1016/j.jemermed.2025.07.051

31. Bertelli E, D'Amico G, Bertolotto M, Miele V. "Penile Ultrasound: An Essential Tool in an Emergency Setting (Traumatic and Non-Traumatic Diseases)." Ultraschall Med. 2022;43(3):232–251. doi:10.1055/a-1748-3995

32. Mulhall JP, Anderson M, Parker M. "Congruence Between Veno-Occlusive Parameters During Dynamic Infusion Cavernosometry: Assessing the Need for Cavernosography." Int J Impot Res. 2004;16(2):146–149. doi:10.1038/sj.ijir.3901177

33. Lowe MA, Schwartz AN, Berger RE. "Controlled Trial of Infusion Cavernosometry in Impotent and Potent Men." J Urol. 1991;146(3):783–785. doi:10.1016/s0022-5347(17)37920-x

34. Porst H, van Ahlen H, Vahlensieck W. "Relevance of Dynamic Cavernosography to the Diagnosis of Venous Incompetence in Erectile Dysfunction." J Urol. 1987;137(6):1163–1167. doi:10.1016/s0022-5347(17)44435-1

35. Meuleman EJ, Wijkstra H, Doesburg WH, Debruyne FM. "Comparison of the Diagnostic Value of Pump and Gravity Cavernosometry in the Evaluation of the Cavernous Veno-Occlusive Mechanism." J Urol. 1991;146(5):1266–1270. doi:10.1016/s0022-5347(17)38065-5

36. Bertolotto M, Campo I, Sachs C, et al. "Sonography of the Penis / Erectile Dysfunction." Abdom Radiol. 2020;45(7):1973–1989. doi:10.1007/s00261-020-02529-z

37. Roudenko A, Wilcox Vanden Berg RN, Song C, et al. "Utility of Dynamic MRA in the Evaluation of Male Erectile Dysfunction." Abdom Radiol. 2020;45(7):1990–2000. doi:10.1007/s00261-019-02339-y

38. Shenoy-Bhangle A, Perez-Johnston R, Singh A. "Penile Imaging." Radiol Clin North Am. 2012;50(6):1167–1181. doi:10.1016/j.rcl.2012.08.009

39. Parker RA, Menias CO, Quazi R, et al. "MR Imaging of the Penis and Scrotum." Radiographics. 2015;35(4):1033–1050. doi:10.1148/rg.2015140161

40. Graziani A, Delbarba A, Nardin M, et al. "Association Between Parameters of Penile Doppler Ultrasound and Cardiovascular Risk in Patients With Erectile Dysfunction: A Single-Center Retrospective Study." J Clin Med. 2026;15(7):2722. doi:10.3390/jcm15072722

41. Vickers MA, Benson CB, Richie JP. "High Resolution Ultrasonography and Pulsed Wave Doppler for Detection of Corporovenous Incompetence in Erectile Dysfunction." J Urol. 1990;143(6):1125–1127. doi:10.1016/s0022-5347(17)40202-3