Penile Doppler Explained: Normal Study vs Arterial Insufficiency and Venous Leak

[madman]

Penile Doppler ultrasound is a vital tool for evaluating vascular causes of erectile dysfunction. In a normal study, adequate arterial inflow is demonstrated by a peak systolic velocity (PSV) greater than 30–35 cm/s, and proper venous occlusion is confirmed by a low end diastolic velocity (EDV) approaching zero. This pattern supports the achievement and maintenance of a firm erection. In contrast, the abnormal case shows a PSV less than 25 cm/s, indicating arterial insufficiency, and a persistently elevated EDV of 5–9 cm/s with continuous diastolic flow, suggesting a venous leak. Together, these findings point to mixed vascular erectile dysfunction. Early diagnosis through penile Doppler is crucial for guiding appropriate management strategies and improving patient outcomes, emphasizing the need for a comprehensive vascular assessment in men with erectile dysfunction.




Normal vs abnormal PDDU

Mixed Vascular Insufficiency

Clinical Implications:

 

[madman]

Normal vs Abnormal Penile Doppler

In simple terms

Briefing: Penile Doppler Ultrasound and Men's Health​

This briefing document summarizes key information from the provided source regarding Penile Doppler Ultrasound (PDDU) for evaluating erectile dysfunction (ED) and introduces a tool for predicting hormone levels in men undergoing Testosterone Replacement Therapy (TRT).

I. Penile Doppler Ultrasound (PDDU) for Erectile Dysfunction​

Penile Doppler ultrasound is presented as a crucial diagnostic tool for identifying vascular causes of erectile dysfunction. The source outlines specific parameters that differentiate a normal study from findings indicative of arterial insufficiency and venous leak.

A. Normal Penile Doppler Study:

• Arterial Inflow: Demonstrated by a peak systolic velocity (PSV) greater than 30–35 cm/s. This indicates sufficient blood flow into the penis.
• Venous Occlusion: Confirmed by a low end diastolic velocity (EDV) approaching zero. This signifies proper trapping of blood within the penis to maintain an erection.
• Outcome: "This pattern supports the achievement and maintenance of a firm erection."

B. Abnormal Penile Doppler Study (Indicative of Vascular ED):

• Arterial Insufficiency: Indicated by a PSV less than 25 cm/s. This suggests inadequate blood flow into the penis.
• Venous Leak: Suggested by a persistently elevated EDV of 5–9 cm/s with continuous diastolic flow. This indicates that blood is escaping the penis prematurely, preventing a firm erection.
• Outcome: "Together, these findings point to mixed vascular erectile dysfunction."

C. Importance of Early Diagnosis:

• The source emphasizes that "Early diagnosis through penile Doppler is crucial for guiding appropriate management strategies and improving patient outcomes, emphasizing the need for a comprehensive vascular assessment in men with erectile dysfunction."

II. TRT Hormone Predictor​

The document also introduces a "TRT Hormone Predictor" tool, designed to estimate estradiol (E2), DHT, and free testosterone levels based on a man's total testosterone value.

A. Input and Output:

• Input: Total testosterone value (normal range: 300-1000 ng/dL).
• Output: Predicted levels of Estradiol (E2), DHT, and Free Testosterone.

B. Understanding Predicted Hormones:

• Estradiol (E2): "A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being."
• DHT (Dihydrotestosterone): "a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects."
• Free Testosterone: "The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects."

C. Medical Disclaimer:

• The tool comes with a significant warning: "This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol."

D. Scientific Reference:

• The predictor is based on research by Lakshman et al. (2010) on "The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men."

 

[madman]

PDDU Images and Views

 

[madman]

PDDU findings

 

[madman]

Analysis of Findings

Interpretation:

 

[madman]

Clinical Implications:

Prognosis:

 

[madman]

Recommended Next Steps:

 

[madman]

Conclusion:

 

[madman]

Thread 'The Value of Penile Ultrasound in ED Diagnosis'

Oct 3, 2023

Sign up for free to watch!

https://register.gotowebinar.com/register/2458027946062758492?source=Email+Template+1

Dr. Helen Bernie will educate on the value of ultrasound for erectile dysfunction (ED) studies during this peer-to-peer webinar. By the end of this webinar, attendees will be able to identify the types of ED and identify areas within their practice where ultrasound is of added value. Attendees will also have a better understanding of how to confidently perform a penile Doppler examination

• madman
• penile doppler; ed/priapism; ultrasound
• Replies: 29
• Forum: When TRT Is Not Enough (ED, Libido, & More)

 

[madman]

Post in thread 'Erectile dysfunction - What Is Penile Venous Leakage?'

Oct 11, 2024

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• madman

 

[Golfboy307]

Conclusion:
View attachment 52660

Thanks for posting all of this information! Fascinating. Without having one of these scans done yet, I am pretty firmly convinced I have both versions going on.