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The False Diagnosis of Venous Leak: Prevalence and Predictors—A Comment

      We have read with interest the article by Teloken et al. [
      • Teloken P.E.
      • Park K.
      • Parker M.
      • Guhring P.
      • Narus J.
      • Mulhall J.P.
      The false diagnosis of venous leak: Prevalence and predictors.
      ], which reevaluated the erectile hemodynamics in 292 men previously diagnosed with venous leak on penile duplex Doppler ultrasound (DUS) done elsewhere. The authors reported that only 74% and 58% of these men were confirmed to have a “true” venous leak with repeat DUS and dynamic infusion cavernosometry (DIC), respectively. They suggested a cautious approach in diagnosing venous leak by DUS and underlined the importance of cavernosometry in such cases. The introduction of phosphodiesterase‐5 (PDE5) inhibitors has revolutionized the management of patients with erectile dysfunction (ED) and diminished the importance of expensive and invasive penile vascular studies. Current guidelines mandate that clinical evaluation of ED should follow an algorithm, starting with administration of sexual symptom questionnaires, followed by detailed medical/sexual history, physical examination, and basic screening laboratory tests [
      • Montorsi F.
      • Adaikan G.
      • Becher E.
      • Giuliano F.
      • Khoury S.
      • Lue T.F.
      • Sharlip I.
      • Althof S.E.
      • Andersson K.E.
      • Brock G.
      • Broderick G.
      • Burnett A.
      • Buvat J.
      • Dean J.
      • Donatucci C.
      • Eardley I.
      • Fugl‐Meyer K.S.
      • Goldstein I.
      • Hackett G.
      • Hatzichristou D.
      • Hellstrom W.
      • Incrocci L.
      • Jackson G.
      • Kadioglu A.
      • Levine L.
      • Lewis R.W.
      • Maggi M.
      • McCabe M.
      • McMahon C.G.
      • Montague D.
      • Montorsi P.
      • Mulhall J.
      • Pfaus J.
      • Porst H.
      • Ralph D.
      • Rosen R.
      • Rowland D.
      • Sadeghi‐Nejad H.
      • Shabsigh R.
      • Stief C.
      • Vardi Y.
      • Wallen K.
      • Wasserman M.
      Summary of the recommendations on sexual dysfunctions in men.
      ,
      • Hatzimouratidis K.
      • Amar E.
      • Eardley I.
      • Giuliano F.
      • Hatzichristou D.
      • Montorsi F.
      • Vardi Y.
      • Wespes E.
      European Association of Urology. Guidelines on male sexual dysfunction: Erectile dysfunction and premature ejaculation.
      ]. As most patients with ED can be managed within the primary care setting, the utility of specific diagnostic tests such as DUS is recommended for few selective cases (e.g., patients with posttraumatic ED or Peyronie's disease) [
      • Hatzimouratidis K.
      • Amar E.
      • Eardley I.
      • Giuliano F.
      • Hatzichristou D.
      • Montorsi F.
      • Vardi Y.
      • Wespes E.
      European Association of Urology. Guidelines on male sexual dysfunction: Erectile dysfunction and premature ejaculation.
      ,
      • Pavlica P.
      • Valentino M.
      • Barozzi L.
      US Evaluation of Erectile Dysfunction.
      ].
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      References

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        The false diagnosis of venous leak: Prevalence and predictors.
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