Table 2 Investigations performed in the individual studies.

From: Hard-flaccid syndrome: a systematic review of aetiopathophysiology, clinical presentation and management

Author, year

Blood tests

Penile Doppler USS

MRI

Other tests

Pang et al. [15]

Normal glucose, lipids, FSH, LH, testosterone, prolactin, thyroid function

Normal

Not performed

NPTR: suboptimal erections; urine tests negative; VAS (penile pain): 3–4 at rest and 6–7 during painful attacks; EHS: 2–3/4 (during flaccid); IIEF-5: 11/25 (moderate); IPSS: 21/35 (severe); NIH-CPSI: 34; HADS-A: 10/21 (borderline); HADS-D: 10/21 (borderline)

 

Normal glucose, lipids, FSH, LH, testosterone, prolactin, thyroid function

Normal

Not performed

Urine tests negative; VAS (penile pain): 1; EHS: 2–3/4 (during flaccid); IIEF-5: 17/25 (mild); IPSS: 2/35 (mild); NIH-CPSI: 10; HADS-A: 2/21 (normal); HADS-D: 6/21 (normal)

Gul et al. [2]

Normal glucose, lipids, FSH, LH, testosterone

Normal

Normal

NR

 

Normal glucose, lipids, FSH, LH, testosterone

Normal

Normal

NR

 

Normal testosterone, oestradiol, prolactin

Normal flow, scarring due to PD

NR

NR

 

Normal FSH, LH, testosterone, oestradiol, prolactin

Normal

NR

NR

Nico et al. [9]

Normal

Normal

NR

NR

Sullivan et al. [17]

NR

All had normal PSV: Mean 45 (SD,−35) cm/s; 2 (2.3%) had abnormal EDV: Mean 2 (SD, 11) cm/s

NR

NR

Goldstein and Komisaruk, [4]

NR

NR

L5-S1 disc protrusion with annular tear

Neurogenital testing

Billis et al. [8]

Normal

Normal

NR

Transabdominal USS: low pelvic floor muscle mobility; IIEF-5: 18 (mild); urine tests negative; HADS-A: 11 (moderate); HADS-D: 9 (mildly elevated); VAS: 5–6 (deep perineal pain); Pelvic floor muscle strength: 4+ (Oxford scale)

Yazar et al. [7]

Normal testosterone, prolactin, thyroid function

Mild corporal fibrosis

NR

NR

Goldstein, [16]

NR

NR

16/21 (76%) had surgically treatable annular tears, L4-L5 or L5-S1

NR

  1. EHS erectile hardness score, FSH follicle-stimulating hormone, HADS hospital anxiety and depression scale, IIEF-5 international index for erectile function-5, IPSS international prostate symptom score, LH luteinizing hormone, NIH-CPSI national institutes of health chronic prostatitis symptom index, NPTR nocturnal penile tumescence rigidity test, NR not reported, PD peyronie’s disease, USS ultrasound scan, VAS visual analogue scale.