Aims: Penile Doppler Ultrasound (PDU) combined with intracavernosal injection (ICI) of vasoactive agent papaverine is an established diagnostic test for evaluation of penile hemodynamics in patients with erectile dysfunction (ED). The present study investigated the clinical utility of oral sildenafil citrate (a safer vasoactive agent) along with audiovisual sexual stimulation (AVSS) for non-invasive duplex Doppler ultrasound evaluation of vasculogenic ED. Methods and Material: This Institutional Ethics Committee approved observational study included 36 patients with complaints of ED, referred from the department of urology for pharmaco PDU investigation, between April 2017 and May 2018. All these patients with International Index of Erectile Function-5 (IIEF-5) score < 25, underwent grey scale and Doppler ultrasound examination of the penis in flaccid as well as erection phase. Oral sildenafil citrate (50-100 mg) was administered and audiovisual sexual stimulation (AVSS) was provided for pharmaco-erection. Pre and post-medication cavernosal arterial diameters, peak systolic velocities (PSVs), end-diastolic velocities (EDVs), and resistance indices (RIs) were recorded. Pre and post sildenafil cavernosal artery diameters, PSVs and EDVs were compared using paired t test. Results: The differences in the pre and post- medication cavernosal arterial diameters, PSVs and EDVs were statistically significant (P<0.05). On PDU examination, 23 patients showed arterial insufficiency, three had venous insufficiency, one patient recorded combined arterial and venous insufficiency and nine patients were considered normal. Conclusions: Penile duplex Ultrasound using oral sildenafil citrate combined with AVSS is a safe, non-invasive and effective, first-line screening test for assessing vasculogenic ED.
