الفهرس 
IV. INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Erectile dysfunction is a widespread problem affecting many men across all age groups and disturbing the quality of life of sexually active men.
Earlier ED was included in the general term impotence, with non-specific meaning, which also referred to other disorders of male sexual function, such as orgasmic and ejaculatory dysfunction. Erectile dysfunction (ED) is the more precise term, especially given the fact that sexual desire and the ability to have an orgasm and ejaculate may be intact despite the inability to achieve or maintain an erection.
Although ED is a benign disorder, it affects physical and psychosocial health and has a significant impact on the quality of life (QoL) of sufferers and their partners and families. Approximately 5-20% of men have moderate to severe ED.
Erectile Dysfunction (ED) is one of the major social problems causing significant distress in men. Despite the increasing difficulty in management, knowledge, and understanding of factors responsible for its development are important for prevention and care.
Risk factors for ED include age, diabetes, hypertension, obesity, lack of exercise, dyslipidemia, smoking, depression, lower urinary tract symptoms, and pelvic surgery; some of which can be modified.
In accordance with the International Society of Impotence Research, ED may be classified into three subtypes: organic (that includes iatrogenic, neurogenic, vasculogenic and hormonal), psychogenic and mixed erectile dysfunction. A thorough investigation ought to be performed by a multidisciplinary team in order to avoiding misdiagnosis.
Vascular insufficiency is one of the major causes of ED, and historically, vascular evaluation has had a significant role in the assessment of ED Vascular insufficiency can be divided into arterial insufficiency and venous leak (corporal veno-occlusive dysfunction, CVOD). Prior to the evolution of penile duplex doppler ultrasound (DUS), cavernosometry existed and permitted the evaluation of the integrity of the cavernosal artery inflow as well as the veno-occlusive mechanism. The modern sexual medicine clinician is likely not to have been trained in cavernosometry, and given the less invasive nature of DUS, the latter has supplanted cavernosometry in the vast majority of centers including tertiary referral sexual medicine practices. Furthermore, it is suggested that DUS is less time consuming and requires less specialized equipment and facilities than cavernosometry.
The aim of this study was to carefully reassess and define the erectile hemodynamic status in men who had been assigned a previous diagnosis of venous leak on DUS by re-evaluation of DUS under guidelines of Australasian Society for Ultrasound in Medicine (ASUM).
Our study was conducted in the period from 2014 to 2016; cases were obtained from andrology clinic of Menoufiya university hospital. During this study, 50 cases were studied .Their ages ranged from 18 to 50 years old.
All cases were subjected to the following:
I. Detailed history.
II. Thorough physical examination.
III. Laboratory studies: Glycated Hemoglobin (Hb A1C) & prolactin were done to every patient and any subject with any abnormality was excluded from the study.
IV. Imaging studies: Patients who matched these inclusion and exclusion criteria were subjected to re-evaluation via pharmaco-penile duplex ultrasonography under guidelines of Australasian Society for Ultrasound in Medicine (ASUM).
The repeat DUS was done in a quiet relaxed environment free of interruption to remove any discomfort or anxiety that may affect the results.
We performed the repeat DUS using a single injection of 30 mg of papaverine. Spectral Doppler waveforms were performed at 0 mins, 2 mins, 5 mins, 10 mins, 15 mins, 20 mins, 25 mins, in the proximal 1/3 of each cavernosal artery.
We have demonstrated in this study that 50% of patients who underwent penile DUS elsewhere and were diagnosed as venous leak were proved to be normal when re-evaluated by DUS under guidelines of Australasian Society for Ultrasound in Medicine (ASUM).
The other 50% demonstrated a significant improvement in the value of end diastolic velocity (EDV) in repeat DUS.
We have demonstrated in this study that there is a significant increase in the value of peak systolic velocity (PSV) in repeat DUS with guidelines with mean difference of ↑10.29 than the original DUS.
Also, there is a significant decrease in the value of End diastolic velocity (EDV) in repeat DUS with guidelines with mean difference of ↓4.19 than the original DUS.
Results showed significant negative correlation between age and value of peak systolic velocity for all participants in both original and repeat DUS.
Also, insignificant positive correlation was found between age and value of end diastolic velocity for all participants in both original and repeat DUS.