{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T22:37:43Z","timestamp":1792363063350,"version":"4.4.0"},"reference-count":52,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Andrology"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Because it is a superficial structure, the penis is ideally suited to ultrasound imaging. A number of disease processes, including Peyronie's disease, penile fractures and tumors, are clearly visualized with ultrasound. Baseline and dynamic assessment of cavernosal arterial changes after pharmaco\u2010stimulation with alprostadil allows standardized diagnosis of arterial and venogenic causes of erectile dysfunction (ED).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To illustrate how to correctly perform flaccid and dynamic penile duplex ultrasound (D\u2010PDU) and in which patients to recommend it.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials\/Methods<\/jats:title><jats:p>An extensive search of the literature was carried out on Pubmed with the insertion of the following Medical Subjects Headings (MeSH) terms and keywords \u201cpenile color Doppler ultrasound\u201d \u201cpeak systolic velocity\u201d \u201cend\u2010diastolic velocity\u201d, \u201cacceleration time\u201d, \u201cresistance index\u201d.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evidence<\/jats:title><jats:p>In our experience, arterial erectile dysfunction is identified after standardized intracavernous injection (ICI) of alprostadil (10\u00a0mcg) when values of peak systolic velocity (PSV) are &lt;35\u00a0cm\/s and, in the most severe forms, for values &lt;25\u00a0cm\/s. Arterial insufficiency can also be identified by increased acceleration time (AT) values (&gt;110\u00a0ms) and\/or by a lack of visualization of helicine arteries at power Doppler mode along with incomplete achievement of penile rigidity. The veno\u2010occlusive incompetence is determined when end\u2010diastolic velocity (EDV) values are &gt;4.5\u20135\u00a0cm\/s or in the case of resistance index (RI) values &lt;0.75. The assessment of additional surrogate markers of endothelial dysfunction, that is, intima\u2010media thickness, mean platelet volume (MPV), endothelial progenitor cells (EPC), endothelial cell specific molecule\u20101(endocan) are also useful in assessing the patient's cardiovascular risk but are still considered investigational in the interpretation of D\u2010PDU results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>D\u2010PDU scan after ICI with vasoactive drugs is a safe procedure and represents the gold standard for the diagnostics of penile pathologies and should be performed in men with ED not responding to oral conventional therapies and\/or in those requiring accurate stratification of cardiovascular 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