{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T20:41:21Z","timestamp":1777581681078,"version":"3.51.4"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000},"content-version":"vor","delay-in-days":20,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In the evaluation of men presenting for erectile dysfunction (ED), specific diagnostic tests, such as an intracavernous injection test (IIT) with Erection Hardness Score (EHS) assessment or penile Doppler ultrasound (PDU), may be necessary.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>The study sought to compare the prognostic value of PDU parameters with erection rigidity with EHS during IIT in predicting refractory ED after 5 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients referred for ED were evaluated and had a PDU with at least 15 \u03bcg of intracavernous alprostadil and without any sexual stimulation. At 5 years of follow-up, current and past ED treatments were noted. Refractory ED was defined as having a penile prosthesis (PP) implanted, having failed nonsurgical treatments but having refused PP implantation, or having discontinuation of nonsurgical treatments due to loss of efficacy. Patients with hypogonadism and pelvic surgery were excluded. Receiver-operating characteristic curves were drawn and the area under the curve (AUC) was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcomes<\/jats:title><jats:p>The outcome was the AUC for predicting refractory ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 5\u00a0years, 69 men were still in follow-up with a mean age of 58.47\u2009\u00b1\u200910.39\u00a0years, and 13 (18.8%) were classified as having refractory ED. The AUC for the EHS, peak systolic velocity, end-diastolic flow, and resistive index to discriminate refractory ED were 0.820, 0.613, 0.730, and 0.714, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Implications<\/jats:title><jats:p>EHS can be a good predictor of response to nonsurgical treatments in ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Strengths and Limitations<\/jats:title><jats:p>This was a prospective study to compare IIT with PDU, and validated disease-specific questionnaires were used to assess both clinical efficacy and satisfaction. PDU was performed by a blinded third party. However, resulting from a single-center study, our sample size can be considered small, and the number of events observed was also low.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our data suggest that an abnormal EHS during an IIT is, at least, noninferior than an abnormal PDU in predicting those patients that will not respond to nonsurgical treatments and that will need a PP in long-term.<\/jats:p><\/jats:sec>","DOI":"10.1093\/sexmed\/qfad009","type":"journal-article","created":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T07:00:22Z","timestamp":1679382022000},"source":"Crossref","is-referenced-by-count":7,"title":["Erection hardness score or penile Doppler ultrasound: which is a better predictor of failure of nonsurgical treatment of erectile dysfunction?"],"prefix":"10.1093","volume":"11","author":[{"given":"Alberto Costa","family":"Silva","sequence":"first","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o Servi\u00e7o de Urologia, , 4200-319, Porto, Portugal"}]},{"given":"Carlos Martins","family":"Silva","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o Servi\u00e7o de Urologia, , 4200-319, Porto, Portugal"},{"name":"Faculdade de Medicina da Universidade do Porto , 4200-319, Porto, Portugal"}]},{"given":"Afonso","family":"Morgado","sequence":"additional","affiliation":[{"name":"Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o Servi\u00e7o de Urologia, , 4200-319, Porto, Portugal"}]}],"member":"286","published-online":{"date-parts":[[2023,3,21]]},"reference":[{"issue":"6","key":"2023032106554710200_","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1111\/j.1743-6109.2007.00745.x","article-title":"Prevalence, severity, and risk factors for erectile dysfunction in a representative sample of 3,548 Portuguese men aged 40 to 69 years attending primary healthcare centers: results of the Portuguese erectile dysfunction study","volume":"5","author":"Teles","year":"2008","journal-title":"J Sex Med"},{"issue":"4","key":"2023032106554710200_","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1177\/14746514020020040801","article-title":"Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study","volume":"2","author":"Levy","year":"2002","journal-title":"Br J Diabetes Vasc Dis"},{"issue":"7","key":"2023032106554710200_","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1111\/jsm.12179","article-title":"One patient out of four with newly diagnosed erectile dysfunction is a young man-worrisome picture from the everyday clinical practice","volume":"10","author":"Capogrosso","year":"2013","journal-title":"J Sex Med"},{"issue":"9861","key":"2023032106554710200_","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/S0140-6736(12)60520-0","article-title":"Erectile dysfunction","volume":"381","author":"Shamloul","year":"2013","journal-title":"Lancet"},{"issue":"5","key":"2023032106554710200_","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.14336\/AD.2019.1028","article-title":"Practical approaches to treat ED in PDE5i nonresponders","volume":"11","author":"Cai","year":"2020","journal-title":"Aging Dis"},{"issue":"7541","key":"2023032106554710200_","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1136\/bmj.332.7541.589","article-title":"Treating erectile dysfunction when PDE5 inhibitors fail","volume":"332","author":"McMahon","year":"2006","journal-title":"Br Med J"},{"key":"2023032106554710200_","volume-title":"Sexual and Reproductive Health. 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