Penile Doppler Ultrasound for Erectile Dysfunction:

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madman

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Penile Doppler Ultrasound for Erectile Dysfunction: Technique and Interpretation



OBJECTIVE. Erectile dysfunction (ED) is a common medical condition that has a high prevalence and incidence worldwide and may have a significant impact on both physical and psychosocial health. The purpose of this article is to review the role of penile Doppler sonography in the assessment of ED.






Conclusion Despite the fact that introduction of oral phosphodiesterase type 5 inhibitors has given rise to changes in the clinical and diagnostic management of ED, penile Doppler US still plays an important role in the assessment of ED. It allows baseline evaluation of the functional anatomy while providing real time assessment of the dynamic changes experienced in response to the dosing of vasoactive medications.

Becoming familiar with the sonographic protocol, the limitations of the technique, and interpretation of imaging features of penile Doppler US are essential to differentiating between the vascular and nonvascular causes of ED and therefore determining appropriate management of the patient.
 

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madman

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madman

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Fig. 1Normal anatomy of penis. Transverse drawing shows corpora cavernosa and corpus spongiosum surrounded by tunica albuginea. Cavernosal arteries and helicine arteries are located within corpora cavernosa, and corpus spongiosum contains urethra. Buck fascia encircles three corpora, deep dorsal vein, and dorsal arteries, and Dartos fascia encompasses all components of penis. Superficial dorsal vein is located between Buck fascia and Dartos fascia.
 
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madman

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Fig. 2Penile vasculature. A and B, Drawings show arterial supply (A) and venous system (B) of penis.
 

madman

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Fig. 3Sonographic images of anatomy of penis. A–D, Ultrasound images obtained in transverse (A and B) and longitudinal (C and D) planes show corpora cavernosa (1), corpus spongiosum (2), tunica albuginea (3), cavernosal artery (4), deep dorsal vein (5), and helicine arteries (6).
 

madman

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Fig. 4Physiologic changes in corpus cavernosum during erection.
A, Illustration of flaccid penis shows that helicine arteries and smooth muscle cells of sinusoids are normally contracted.
B, Illustration shows erect penis after parasympathetic stimulation. Smooth muscle cells relax and, consequently, helicine arteries and sinusoidal smooth muscles expand, filling cavernosal spaces and decreasing venous outflow.
 

madman

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Fig. 666-year-old man with arteriogenic erectile dysfunction. Vmax = peak systolic velocity, Ved = end-diastolic velocity, PI = pulsatility index, RI = resistance index, S/D = systolic/diastolic ratio, Vmin = minimum velocity, Vm_pico = mean peak velocity, Vm_mean = mean velocity, HR = heart rate, CA = cavernosal artery, LW = linear transducer, diff = differential, CF = color flow, fps = frames per second, MI = mechanical index, DR = dynamic range, CG = color gain, PRF = pulse repetition frequency. A and B, Penile Doppler ultrasound images obtained after intracavernosal administration of 10 µg of prostaglandin E1 show flows with low speed in right (A) and left (B) cavernosal arteries, both with maximum peak systolic velocity of less than 25 cm/s at all intervals and low-resistance spectral waveforms, compatible with arterial insufficiency.
 

madman

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Fig. 7—55-year-old man with unilateral cavernosal artery insufficiency. Vmax = peak systolic velocity, Vmin = minimum velocity, Ved = end-diastolic velocity, Vm_pico = mean peak velocity, Vm_mean = mean velocity, PI = pulsatility index, RI = resistance index, S/D = systolic/diastolic ratio, CA = cavernosal artery, L5 = linear transducer, CF = color flow, fps = frames per second, MI = mechanical index, DG = depth gain, DR = dynamic range, CG = color gain, PRF = pulse repetition frequency. A and B, Penile Doppler ultrasound images obtained after intracavernosal injection show difference of more than 10 cm/s between peak systolic velocity of two cavernosal arteries. Maximal peak systolic velocity in right cavernosal artery (A) was 44.4 cm/s and that in left cavernosal artery (B) was 15.7 cm/s, which are findings suggestive of left arterial insufficiency.
 

madman

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Fig. 8—38-year-old man with venogenic erectile dysfunction. Vmax = peak systolic velocity, Ved = end-diastolic velocity, PI = pulsatility index, RI = resistance index, S/D = systolic/diastolic ratio, Vmin = minimum velocity, Vm_pico = mean peak velocity, Vm_mean = mean velocity, HR = heart rate, CA = cavernosal artery, LW = linear transducer, diff = differential, CF = color flow, fps = frames per second, MI = mechanical index, DR = dynamic range, CG = color gain, PRF = pulse repetition frequency. A and B, Penile Doppler ultrasound images show normal arterial inflow parameters in right (A) and left (B) cavernosal arteries (peak systolic velocity, > 30 cm/s) with end-diastolic velocity greater than 5 cm/s and RI less than 0.75, suggestive of venous incompetence.
 

madman

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Fig. 9—Peyronie disease. A–D, Gray-scale ultrasound images obtained in transverse (A and B) and longitudinal (C and D) planes show curvilinear hyperechoic lesions with posterior acoustic shadowing in region of tunica albuginea in dorsal aspect of both corpora cavernosa (A and C). Calcified plaque is seen in penile septum (B), and fibrous plaque appears as nodular hypoechoic lesion with focal calcifications in tunica albuginea (D). Dashed lines A and B in image in C denote calcified plaques in dorsal tunica albuginea of corpora cavernosa. Dashed lines A and B in image in D delimit fibrous plaque in dorsal aspect of corpora cavernosa.
 

madman

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Fig. 10—46-year-old man with penile fracture. A and B, Gray-scale Doppler ultrasound images obtained in transverse (A) and longitudinal (B) planes show focal defect in tunica albuginea (dashed arrow, B) and small collection in adjacent corpus cavernosum (solid arrow, A and B).
 

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