Assessment of Erectile Dysfunction Using Duplex Color Doppler Ultrasonography: Significance of Phentolamine Redosing in Correcting Venous Leak Misdiagnosing: a Retrospective Study

Objective:-To analyze the hemodynamic response of penile vasculature following intracavernosal pharmacological stimulation with prostaglandin E1 (PGE1) and phentolamine by Doppler Ultrasound Materials & Method:-This cross-sectional study was carried out from December 2024 to November 2025 at University of Lahore affiliated Ultrasound Clinic, Lahore. Duplex Color Doppler Ultrasonography was used to assess 86 consecutive individuals who had been clinically diagnosed with erectile dysfunction. In order to avoid nicotine-induced vasospasm and elevated sympathetic tone, which might impact penile hemodynamics, patients who smoked were instructed to quit at least 72 hours before the assessment. The investigation was conducted in a quiet, private setting with the patient in the supine position with the penis in its natural anatomical orientation after obtaining informed permission and evaluating pertinent drug and cardiac history. The GE Logiq 500 MD's high-frequency (7.5 MHz) linear transducer was used for imaging.Before and after intracavernosal injection of prostaglandin E1, longitudinal and transverse scans in grayscale and color Doppler modes were acquired using ultrasound gel applied to the ventral penile surface. Prior to pharmacologic stimulation, baseline measures of cavernosal artery diameter and peak systolic velocity were taken. The pre-injection examination assessed the flaccid penis for structural abnormalities such as plaques, fibrosis, or tunical deformities. Results:-Among 86 patients with erectile dysfunction, 42 (48.8%) initially demonstrated suspected venous leak on duplex Doppler ultrasonography. Following phentolamine redosing, 25 (59.5%) showed improved erectile hemodynamics, with increased mean PSV (28.6 to 34.2 cm/s) and decreased mean EDV (6.8 to 2.9 cm/s). After reassessment, 17 (19.8%) patients remained classified as having suspected venous leak. These illustrative findings suggest that phentolamine redosing may help reduce potential false-positive diagnoses of venous leak. Conclusion:-Phentolamine redosing may improve erectile hemodynamics and reduce false-positive diagnoses of venous leak when the initial pharmacological response is inadequate