{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T18:45:37Z","timestamp":1776019537859,"version":"3.50.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Arteriogenic insufficiency (AI) is the most common vascular cause of erectile dysfunction (ED) and is traditionally diagnosed using semi-invasive papaverine-induced penile Doppler ultrasonography (P-PDUS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the feasibility and diagnostic accuracy of the cavernosal artery ondulation index (CA-OI) measured during the flaccid penile phase for identifying AI in men with ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective study included 90 men with clinically confirmed ED (International Index of Erectile Function-5\u2009\u2264\u200925) and suspected vascular etiology. Gray-scale and color Doppler ultrasonography were performed in the flaccid state to measure CA-OI. AI was diagnosed according to established P-PDUS criteria, and patients were classified into AI (n\u2009=\u200928) and non-AI (n\u2009=\u200962) groups. CA-OI values were compared between groups, and receiver operating characteristic curve analysis was used to evaluate diagnostic performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>The primary outcome was the diagnostic accuracy of flaccid-phase CA-OI for detecting AI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients with AI were significantly older than those without AI (59.8\u2009\u00b1\u20098.8 vs. 46.4\u2009\u00b1\u200913.5\u00a0years, P\u2009&amp;lt;\u2009.001) and had a higher prevalence of diabetes mellitus (P\u2009&amp;lt;\u2009.001). Mean CA-OI values were significantly higher in the AI group (2.76\u2009\u00b1\u20090.28 vs. 2.33\u2009\u00b1\u20090.17, P\u2009&amp;lt;\u2009.001). Receiver operating characteristic analysis demonstrated excellent diagnostic performance, with an area under the curve of 0.906. A CA-OI cut-off value of 2.46 yielded 89.3% sensitivity and 79% specificity for identifying AI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>Measurement of CA-OI in the flaccid phase offers a non-invasive and clinically practical approach for the initial screening of arteriogenic ED, potentially reducing the need for intracavernosal injection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths and Limitations<\/jats:title>\n                    <jats:p>The principal strength of this study is the first evaluation of CA-OI as a non-invasive diagnostic marker obtained during the flaccid penile phase; limitations include the single-center design and the use of P-PDUS rather than angiography as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CA-OI measured during the flaccid penile phase is a highly accurate, non-invasive marker for AI in men with ED.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdag090","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T12:40:07Z","timestamp":1773924007000},"source":"Crossref","is-referenced-by-count":0,"title":["A novel non-invasive diagnostic marker for arterial erectile dysfunction: cavernosal artery ondulation index measured in the flaccid phase"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3957-1770","authenticated-orcid":false,"given":"G\u00f6ksel","family":"Tuzcu","sequence":"first","affiliation":[{"name":"Department of Radiology, Ayd\u0131n Adnan Menderes University, Faculty of Medicine , Ayd\u0131n ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9677-5673","authenticated-orcid":false,"given":"Erhan","family":"Ate\u015f","sequence":"additional","affiliation":[{"name":"Department of Urology, Ayd\u0131n Adnan Menderes University, Faculty of Medicine , Ayd\u0131n ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5641-7362","authenticated-orcid":false,"given":"Ali","family":"Alka\u015fi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ayd\u0131n Adnan Menderes University, Faculty of Medicine , Ayd\u0131n ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4231-6824","authenticated-orcid":false,"given":"Aral","family":"Varol","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ayd\u0131n Adnan Menderes University, Faculty of Medicine , Ayd\u0131n ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2124-865X","authenticated-orcid":false,"given":"\u00c7a\u011fatay","family":"\u00d6zsoy","sequence":"additional","affiliation":[{"name":"Department of Urology, Ayd\u0131n Adnan Menderes University, Faculty of Medicine , Ayd\u0131n ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7021-0984","authenticated-orcid":false,"given":"Mustafa","family":"G\u00f6k","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ayd\u0131n Adnan Menderes University, Faculty of Medicine , Ayd\u0131n ,","place":["Turkey"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"issue":"1","key":"2026041214284265900_ref1","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/S0022-5347(17)34871-1","article-title":"Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study","volume":"151","author":"Feldman","year":"1994","journal-title":"J Urol"},{"key":"2026041214284265900_ref2","doi-asserted-by":"publisher","first-page":"16003","DOI":"10.1038\/nrdp.2016.3","article-title":"Erectile dysfunction","volume":"2","author":"Yafi","year":"2016","journal-title":"Nat Rev Dis Primers"},{"issue":"8","key":"2026041214284265900_ref3","doi-asserted-by":"publisher","first-page":"1416","DOI":"10.1016\/j.jsxm.2020.05.023","article-title":"A critical analysis of methodology pitfalls in duplex Doppler ultrasound in the evaluation of patients with erectile dysfunction: technical and interpretation deficiencies","volume":"17","author":"Nascimento","year":"2020","journal-title":"J Sex Med"},{"issue":"1","key":"2026041214284265900_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2025.04.010","article-title":"European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 update on male hypogonadism, erectile dysfunction, premature ejaculation, and Peyronie\u2019s disease","volume":"88","author":"Salonia","year":"2025","journal-title":"Eur Urol"},{"issue":"1","key":"2026041214284265900_ref5","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1111\/j.1743-6109.2012.02825.x","article-title":"Standardization of vascular assessment of erectile dysfunction: standard operating procedures for duplex ultrasound","volume":"10","author":"Sikka","year":"2013","journal-title":"J Sex Med"},{"issue":"3","key":"2026041214284265900_ref6","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1148\/radiology.155.3.3890009","article-title":"Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis","volume":"155","author":"Lue","year":"1985","journal-title":"Radiology."},{"issue":"7","key":"2026041214284265900_ref7","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/S0009-9260(03)00112-0","article-title":"Colour Doppler ultrasound of the penis","volume":"58","author":"Wilkins","year":"2003","journal-title":"Clin Radiol"},{"issue":"1","key":"2026041214284265900_ref8","doi-asserted-by":"publisher","first-page":"16","DOI":"10.14366\/usg.17022","article-title":"Penile Doppler ultrasonography revisited","volume":"37","author":"Jung","year":"2018","journal-title":"Ultrasonography."},{"issue":"10","key":"2026041214284265900_ref9","first-page":"1382","article-title":"A new parameter in the diagnosis of vascular erectile dysfunction with penile Doppler ultrasound: cavernous artery ondulation index","volume":"17","author":"Yildirim","year":"2013","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"1","key":"2026041214284265900_ref10","doi-asserted-by":"publisher","first-page":"11318","DOI":"10.1038\/s41598-024-61527-z","article-title":"Global intracranial arterial tortuosity is associated with intracranial atherosclerotic burden","volume":"14","author":"Eun","year":"2024","journal-title":"Sci Rep"},{"issue":"1","key":"2026041214284265900_ref11","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s43044-021-00192-3","article-title":"Is coronary artery tortuosity a precursor of atherosclerosis and\/or left ventricular diastolic dysfunction?","volume":"73","author":"Dakhil","year":"2021","journal-title":"Egypt Heart J"},{"issue":"6","key":"2026041214284265900_ref12","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1016\/S0090-4295(97)00238-0","article-title":"The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction","volume":"49","author":"Rosen","year":"1997","journal-title":"Urology."},{"issue":"5","key":"2026041214284265900_ref13","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1111\/j.1464-410X.2008.08037.x","article-title":"Vasculogenic erectile dysfunction in teenagers: a 5-year multi-institutional experience","volume":"103","author":"Tal","year":"2009","journal-title":"BJU Int"},{"issue":"5","key":"2026041214284265900_ref14","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1038\/s41443-018-0061-3","article-title":"Variability in penile duplex ultrasound international practice patterns, technique, and interpretation: an anonymous survey of ISSM members","volume":"30","author":"Butaney","year":"2018","journal-title":"Int J Impot Res"},{"issue":"4","key":"2026041214284265900_ref15","doi-asserted-by":"publisher","first-page":"e13996","DOI":"10.1111\/and.13996","article-title":"Role of shear wave elastography measured in the flaccid state in predicting arteriogenic erectile dysfunction","volume":"53","author":"Zhang","year":"2021","journal-title":"Andrologia."},{"issue":"1","key":"2026041214284265900_ref16","doi-asserted-by":"publisher","first-page":"e5721","DOI":"10.1002\/pds.5721","article-title":"Oral phosphodiesterase type 5 inhibitors and priapism: a VigiBase analysis","volume":"33","author":"Abbasi","year":"2024","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"3","key":"2026041214284265900_ref17","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1046\/j.1464-4096.2001.01510.x","article-title":"Low-flow priapism: risk factors for erectile dysfunction","volume":"89","author":"El-Bahnasawy","year":"2002","journal-title":"BJU Int"},{"issue":"1 Pt 2","key":"2026041214284265900_ref18","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1111\/j.1743-6109.2009.01625.x","article-title":"Priapism: pathogenesis, epidemiology, and management","volume":"7","author":"Broderick","year":"2010","journal-title":"J Sex Med"},{"issue":"11","key":"2026041214284265900_ref19","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1111\/j.1464-410X.2012.11080.x","article-title":"A review of outcomes of an intracavernosal injection therapy programme","volume":"110","author":"Coombs","year":"2012","journal-title":"BJU Int"},{"issue":"3","key":"2026041214284265900_ref20","doi-asserted-by":"publisher","first-page":"802","DOI":"10.1016\/S0022-5347(01)66315-8","article-title":"The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience","volume":"155","author":"Porst","year":"1996","journal-title":"J Urol"},{"issue":"5","key":"2026041214284265900_ref21","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1111\/andr.13029","article-title":"The penile duplex ultrasound: how and when to perform it?","volume":"9","author":"Aversa","year":"2021","journal-title":"Andrology."},{"key":"2026041214284265900_ref22","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.ejrad.2017.01.029","article-title":"The value of shear wave elastography in the quantification of corpus cavernosum penis rigidity and its alteration with age","volume":"89","author":"Inci","year":"2017","journal-title":"Eur J Radiol"},{"issue":"2","key":"2026041214284265900_ref23","doi-asserted-by":"publisher","first-page":"114","DOI":"10.2478\/v10019-012-0012-4","article-title":"Evaluation of penile erection rigidity in healthy men using virtual touch tissue quantification","volume":"46","author":"Zheng","year":"2012","journal-title":"Radiol Oncol"},{"issue":"6","key":"2026041214284265900_ref24","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1002\/jum.15502","article-title":"Evaluation of arterial erectile dysfunction using shear wave elastography: a feasibility study","volume":"40","author":"Zhou","year":"2021","journal-title":"J Ultrasound Med"},{"issue":"3","key":"2026041214284265900_ref25","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1159\/000335123","article-title":"Twisted blood vessels: symptoms, etiology and biomechanical mechanisms","volume":"49","author":"Han","year":"2012","journal-title":"J Vasc Res"},{"issue":"5","key":"2026041214284265900_ref26","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1177\/000331979804900505","article-title":"Tortuosity, kinking, and coiling of the carotid artery: expression of atherosclerosis or aging?","volume":"49","author":"Del Corso","year":"1998","journal-title":"Angiology."},{"issue":"11","key":"2026041214284265900_ref27","doi-asserted-by":"publisher","first-page":"2450","DOI":"10.1161\/01.STR.0000185679.62634.0a","article-title":"Variation in the carotid bifurcation geometry of young versus older adults: implications for geometric risk of atherosclerosis","volume":"36","author":"Thomas","year":"2005","journal-title":"Stroke."},{"issue":"2","key":"2026041214284265900_ref28","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1038\/sj.ijir.3900347","article-title":"Does severity of ischaemic coronary disease correlate with erectile function?","volume":"10","author":"Sullivan","year":"1998","journal-title":"Int J Impot Res"},{"issue":"4","key":"2026041214284265900_ref29","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1179\/1743132814Y.0000000327","article-title":"Aneurysm geometry in predicting the risk of rupture: a review of the literature","volume":"36","author":"Zanaty","year":"2014","journal-title":"Neurol Res"},{"issue":"1","key":"2026041214284265900_ref30","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1136\/neurintsurg-2014-011477","article-title":"Hemodynamic-morphological discriminant models for intracranial aneurysm rupture remain stable with increasing sample size","volume":"8","author":"Xiang","year":"2016","journal-title":"J Neurointerv Surg"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/5\/qdag090\/68019780\/qdag090.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/5\/qdag090\/68019780\/qdag090.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T18:28:47Z","timestamp":1776018527000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/doi\/10.1093\/jsxmed\/qdag090\/8650588"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":30,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,4,9]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdag090","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"value":"1743-6095","type":"print"},{"value":"1743-6109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,4,9]]},"article-number":"qdag090"}}