The False Diagnosis of Venous Leak: Prevalence and Predictors



      As a vascular test, dynamic infusion cavernosometry (DIC) has lost popularity, and in the urologic community, penile duplex Doppler ultrasound (DUS) has become the sole test to investigate a vascular etiology of erectile dysfunction. Vasoactive agent redosing has been shown to increase the accuracy of DUS.


      To define the erectile hemodynamics in men with previously diagnosed venous leak on DUS.


      Prospective data were collected on patients who (i) had been given a diagnosis of venous leak based on an outside DUS; (ii) elected to undergo a repeat DUS; and (iii) when the repeat DUS suggested venous leak, underwent DIC.

      Main Outcome Measures

      DUS: peak systolic velocity and end‐diastolic velocity. DIC: flow to maintain.


      292 patients were included. Mean ± standard deviation age was 44 ± 26 years. On repeat DUS, 19% (56/292) had completely normal hemodynamics and 7% (20/292) had arterial insufficiency only without venous leak. DIC revealed normal hemodynamics in 13% (38/292), while in 58% (152/292) of patients, the venous leak diagnosis was confirmed. Overall, 47% (137/292) of patients who had been given a diagnosis of venous leak had completely normal hemodynamics, and in only 43% (126/292), the venous leak diagnosis was confirmed upon repeat vascular testing. On multivariable analysis, younger age (<45 years), failure to obtain an adequate erection during the original DUS, and having <2 vascular risk factors were predictive of a false diagnosis of venous leak.


      Penile DUS has a propensity to inaccurately assign a diagnosis of venous leak. Great care should be taken when performing DUS especially in younger men without a significant vascular risk factor history, and the failure to obtain a good erection should make the clinician cautious in assigning a diagnosis of venous leak. Furthermore, there still exists a role for cavernosometry, which appears to have a greater accuracy at diagnosing venous leak. Teloken PE, Park K, Parker M, Guhring P, Narus J, and Mulhall JP. The false diagnosis of venous leak: Prevalence and predictors. J Sex Med 2011;8:2344–2349.


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        • Hatzichristou D.
        • Hatzimouratidis K.
        • Bekas M.
        • Apostolidis A.
        • Tzortzis V.
        • Yannakoyorgos K.
        Diagnostic steps in the evaluation of patients with erectile dysfunction.
        J Urol. 2002; 168: 615-620
        • Lobo J.R.
        • Nehra A.
        Clinical evaluation of erectile dysfunction in the era of PDE‐5 inhibitors.
        Urol Clin North Am. 2005; 32: 447-455
        • Aversa A.
        • Sarteschi L.M.
        The role of penile color‐duplex ultrasound for the evaluation of erectile dysfunction.
        J Sex Med. 2007; 4: 1437-1447
        • Altinkilic B.
        • Hauck E.W.
        • Weidner W.
        Evaluation of penile perfusion by color‐coded duplex sonography in the management of erectile dysfunction.
        World J Urol. 2004; 22: 361-364
        • Ghanem H.
        • Shamloul R.
        An evidence‐based perspective to commonly performed erectile dysfunction investigations.
        J Sex Med. 2008; 5: 1582-1589
        • Hatzichristou D.G.
        • Saenz de Tejada I.
        • Kupferman S.
        • Namburi S.
        • Pescatori E.S.
        • Udelson D.
        • Goldstein I.
        In vivo assessment of trabecular smooth muscle tone, its application in pharmaco‐cavernosometry and analysis of intracavernous pressure determinants.
        J Urol. 1995; 153: 1126-1135
        • Vardi Y.
        • Glina S.
        • Mulhall J.P.
        • Menchini F.
        • Munarriz R.
        Cavernosometry: Is it a dinosaur?.
        J Sex Med. 2008; 5: 760-764
        • Gontero P.
        • Sriprasad S.
        • Wilkins C.J.
        • Donaldson N.
        • Muir G.H.
        • Sidhu P.S.
        Phentolamine re‐dosing during penile dynamic colour Doppler ultrasound: A practical method to abolish a false diagnosis of venous leakage in patients with erectile dysfunction.
        Br J Radiol. 2004; 77: 922-9226
        • Mueller S.C.
        • Lue T.F.
        Evaluation of vasculogenic impotence.
        Urol Clin North Am. 1988; 15: 65-76
        • Aversa A.
        • Rocchietti‐March M.
        • Caprio M.
        • Giannini D.
        • Isidori A.
        • Fabbri A.
        Anxiety‐induced failure in erectile response to intracorporeal prostaglandin‐E1 in non‐organic male impotence: A new diagnostic approach.
        Int J Androl. 1996; 19: 307-313
        • Mulhall J.P.
        • Abdel‐Moneim A.
        • Abobakr R.
        • Goldstein I.
        Improving the accuracy of vascular testing in impotent men: Correcting hemodynamic alterations using a vasoactive medication re‐dosing schedule.
        J Urol. 2001; 166: 923-926