DESCRIPTION
Duplex ultrasonography (i.e., duplex grey scale/color ultrasonography, duplex Doppler ultrasound) is used to identify men who have marked arterial insufficiency as the major cause of their impotence. It is recommended when the penile response to pharmacotesting is suboptimal or equivocal. Duplex ultrasonography entails high-resolution sonography with pulsed Doppler blood flow analysis to evaluate the penile arterial status. An injected vasodilator drug (e.g., papaverine hydrochloride, phentolamine mesylate, prostaglandin E1) is given prior to the test to enhance assessment of arterial or venous insufficiency. Real time spatial visualization measures blood velocity patterns in the vessels.
POLICY
Duplex ultrasonography for the diagnosis of erectile dysfunction is considered medically necessary.
ADDITIONAL INFORMATION
There is evidence that due to anxiety some men with normal vascular function may have falsely abnormal duplex ultrasound results because of suppression of response to pharmacological stimulation. An abnormal duplex ultrasound should be interpreted cautiously if there is evidence of psychogenic impotence.
SOURCES
Agency for Health Care Research and Quality. (1990). Diagnosis and Treatment of Impotence. Retrieved March 14, 2003 from http://www.ahcpr.gov/clinic/impot2.htm.
Allen, R. P., Engel, R. M., Smolev, J. K., Brendler, C. B. (1994, June). Comparison of duplex ultrasonography and nocturnal penile tumescence in evaluation of impotence. Journal of Urology, 151 (6), 1525-1529. Retrieved January 19, 2000 from PubMed database.
American Urological Association. (2003, June). The management of priapism. Retrieved December 12, 2007 from http://www.guideline.gov/summary/pdf.aspx?doc_id=3741&stat=1&string=duplex+AND+ultrasonography+AND+erectile+AND+dysfunction
Andresen, R., Wegner, H. E. (1997). Assessment of the penile vascular system with color-coded duplex sonography and pharmacocavernosometry and - graphy in impotent men. Acta Radiologica, 38 (2), 303-308. Abstract retrieved August 8, 2001 from PubMed database.
BlueCross BlueShield Association, Medical Policy Reference Manual. (2002, April). Erectile Dysfunction (2.01.25). Retrieved December 12, 2007 from BlueWeb.
Broderick, G. A. (1998). Evidence based assessment of erectile dysfunction. International Journal of Impotence Research, 10 (Suppl. 2), S64-S73.
Chun, J., Carson, C. C. (2001). Physician-patient dialogue and clinical evaluation of erectile dysfunction. Urologic Clinics of North America, 28 (2), 249-258.
Complete Guide To Medicare Coverage Issues [Computer software]. (2007, July). Diagnosis and treatment of impotence. (NCD 230.4, p. 2-183). St. Anthony Publishing.
Food and Drug Administration. (2000, April). Center for Drug Evaluation and Research. Urology Subcommittee of the Advisory Committee for Reproductive Health Drugs. Retrieved March 12, 2003 from http://www.fda.gov/ohrms/dockets/ac/oo/transcripts/3602t1.rtf.
Golijanin, D., Singer, E., Davis, R., Bhatt, S., Seftel, A., & Dogra, V. (2007). Doppler evaluation of erectile dysfunction - part I. International journal of impotence research, 19 (1), 37-42.
Kattan, S., Collins, J. P., Mohr, D. (1991). Double-blind, cross-over study comparing prostaglandin E1 and papaverine in patients with vasculogenic impotence. Urology, 37 (6), 516-518. Retrieved from PubMed database January 19 2000.
Meuleman, E. J., Bemelmans, B. L., Doesburg, W. H., van Asten, W. N., Skotncki, S. H., Debruyne, F. M. (1992). Penile pharmacological duplex ultrasonography: a dose-effect study comparing papaverine, papaverine/phentolamine and prostaglandin E1. Journal of Urology, 148 (1), 63-66. Abstract retrieved January 19, 2000 from PubMed database.
Milbank, A. J., Goldfarb, D. A. (2003). Urological manifestations of vascular disease. Urologic Clinics of North America, 30 (1), 13-26.
National Institutes of Health. (1992, December). Impotence. NIH Consensus Statement, 10, (4), 1-31.Retrieved August 6, 2001 from http://consensus.nih.gov/cons/091/091_statement.htm.
Pickard, R. S., Oates, C. P., Sethia, K. K., Powell, P. H. (1991). The role of colour duplex ultrasonography in the diagnosis of vasculogenic impotence. British Journal of Urology, 68 (5), 537-540. Abstract retrieved January 19, 2000 from PubMed database.
Sarosdy, M. F., Hudnal, l. C. H., Erickson, D. R., Hardin, T. C. Novicki, D. E. (1989). A prospective double-blind trial of intracorporeal papaverine versus prostaglandin E1 in the treatment of impotence. Journal of Urology, 141 (3), 551-553. Abstract retrieved January 19, 2000 from PubMed database.
Schaffer, E. M., Jarow, Jr., J. P., Vrablic, J., & Jarow, J. P. (2006). Duplex ultrasonography detects clinically significant anomalies of penile arterial vasculature affecting surgical approach to penile straightening. Urology, 2006 (67), 166-169.
Shabsigh, R., Fishman, I. J., Shotland, Y., Karacan, I., Dunn, J. K. (1990). Comparison of penile duplex ultrasonography with nocturnal penile tumescence monitoring for the evaluation of erectile impotence. Journal of Urology, 143 (5), 924-927. Abstract retrieved March 13, 2002 from PubMed database.
ORIGINAL EFFECTIVE DATE: 4/27/1998
MOST RECENT REVIEW DATE: 1/10/2008
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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