彩色多普勒超声在血管性阴茎勃起功能障碍诊断中的应用

目的评估阴茎海绵体注射后彩色多普勒超声对男性血管性阴茎勃起功能障碍（ED）患者诊断作用。方法47例ED患者经阴茎海绵体注射PGE1 30μg诱导勃起后行彩色超声多普勒检查左、右海绵体动脉血流指标,包括收缩期最大流速（PSV）,动脉舒张末期血流速度（EDV）,阻力指数（RI）。结果非血管性ED组41例（87.2%）,其中左、右海绵体动脉PSV分别〉25 cm/s者33例,左右海绵体动脉PSV相加〉50 cm/s者8例。动脉性ED组2例（4.25%）,左右海绵体动脉PSV均〈25 cm/s,背深静脉未见血流。静脉性ED组4例（8.51%）。结论阴茎海绵体注射血管活性药物后多普勒彩色超声对男性血管性ED检查是一种微创而准确的方法。     

血管性勃起功能障碍病人阴茎血流动力学的变化

目的分析血管性勃起功能障碍(ED)病人阴茎血流动力学的变化,提高对该病的诊断和治疗水平.方法对52例血管性ED病人分别采取海绵体内注射试验和阴茎彩色双功能超声等检查,分析其血流动力学变化.结果52例血管性ED(动脉性ED 14例,静脉性ED 26例,混合血管性ED 12例)病人在阴茎勃起的充盈、勃起、充分勃起和强直勃起期均有明显不同的血流动力学变化,表现为充盈、勃起期延长,充分勃起和强直勃起减少等.结论血管性ED会发生明显的阴茎血流动力学变化,了解该变化有助于其正确诊断和采取适当的治疗方法.     

糖尿病性勃起功能障碍的超声研究

目的 应用彩色多普勒超声血流显像(CDFI)技术探讨动脉在糖尿病性勃起功能障碍(ED)中的作用.方法 23例糖尿病性ED患者和30例非糖尿病ED患者经阴茎海绵体注射前列地尔注射液(主要成分为PGE1)10 μg诱导勃起后,行CDFI检查双侧海绵体动脉血流动力学指标,包括收缩期最大流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)及内径(R).结果 PSV和R这两项指标在糖尿病性ED和非糖尿病ED患者中存在差异具有统计学意义,EDV和RI在两组患者中的差异没有统计学意义.糖尿病性ED患者中的动脉性ED明显多于非糖尿病性ED.结论 动脉供血不足在糖尿病性勃起功能障碍发病机制中起着重要作用.阴茎海绵体注射血管活性药物后CDFI对血管性ED检查是一种微创而准确的方法.     

海绵体内联合用药对筛选非血管性勃起功能障碍剂量选择的研究

本文探讨阴茎海绵体内注射前列腺素E1（PGE1）和罂栗碱（PAP）联合用药筛选非血管性勃起功能障碍的剂量选择。对20例勃起功能正常组和25例非血管性勃起功能障碍组采用不同剂量注射,并用多普勒超声检测阴茎海绵体动脉收缩期最大流速（PSV）和舒张期流速（EDV）。结果 1．小剂量（PGE1 10μg PAP7.5mg）联合用药就可明显增加阴茎血流,产生良好的勃起,与ICI前相比有显著差异（P＜0．01）;2．增加剂量与小剂量注射相比阴茎血流稍有增加,但各组间无显著差异（P＞0．05）;3．小剂量联合肜药未出现阴茎持续勃起和局部疼痛。作者认为小剂量联合用药对非血管性勃起功能障碍患者就能产生良好的阴茎血流,多普勒超声可客观地评价阴茎的血流参数,为ICI的药物剂量选择提供依据。     

彩色多普勒超声检查在血管性勃起功能障碍诊断中的应用

目的:评估彩色多普勒超声在诊断血管性勃起功能障碍中的临床价值。方法:应用彩色多普勒超声技术,检测527例疑似血管性勃起功能障碍患者,海绵体注射血管活性药物前、后阴茎海绵体动脉血流动力学。结果:动脉性勃起功能障碍207例(49.88%),静脉性勃起功能障碍144例(34.70%),动静脉性勃起功能障碍64例(15.42%),非血管性勃起功障碍112例(26.99%)。结论:彩色多普勒超声技术是目前诊断血管性勃起功能障碍的一种微创而可靠的检查方法,其能够定量反映阴茎的血流动力学状态,为合理的治疗勃起功能障碍提供有价值的依据。     

声视觉性刺激联合多普勒超声在重度ED患者诊断中的价值

目的 采用自身前后对照探讨声视觉性刺激联合多普勒超声在重度勃起功能障碍(ED)患者诊断中的价值。方法 自2015年6月至2016年7月,在中南大学湘雅三医院泌尿外科门诊对以ED为主诉的患者进行筛选,采用国际勃起功能评分量表-5(IIEF-5)初筛,IIEF-5评分小于8分的重度ED患者纳入研究,共筛选出139例患者。采用自身对照方式,研究对象先后接受两次阴茎彩色多普勒超声检查。第一次检查仅阴茎海绵体注射前列腺素E1(A组),7 d后的第二次检查予以声视觉性刺激(AVSS)联合阴茎海绵体注射前列腺素E1(B组)。采集注射后第5、10、20 min的收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、血流阻力指数(RI)。结果 在第一期检测中(A组),共有117例患者被检测为血管性ED,包括54例动脉性ED、40例静脉性ED、23例混合性ED。在第二期检测中(B组),共有91例患者被检测为血管性ED,包括34例动脉性ED、30例静脉性ED、27例混合性ED。B组患者加入AVSS后需要的血管活性药物注射剂量与次数明显低于A组,同时发现AVSS联合ICI可以提高非血管性ED检出率,26例患者...     

多普勒超声在静脉性勃起功能障碍诊断中的应用价值研究

目的：探讨Doppler超声在静脉性勃起功能障碍（ED）诊断中的应用价值。方法：10例静脉性ED者在阴茎海绵体内血管活性药物注射（ICI）后，行Doppler超声检查，并同时海绵体内灌注生理盐水，动态观察不同勃起状态海绵体动脉舒张期血流变化，30例心理性ED者仅ICI后行Doppler超声检查作对照。结果：静脉性ED者在勃起硬度差时，海绵体动脉舒张期表现为前向血流（正值表示），随着海绵体内生理盐水灌注后，勃起硬度逐渐增加，舒张末期血流消失；达正常勃起时，舒张期表现逆向血清（负值表示）。心理性ED者在阴茎膨胀期、海绵体动脉舒张期表现前向血流，正常勃起时，舒张期表现逆向血流。结论：在海绵体动脉供血正常情况下，静脉关闭障碍导致海绵体内压受损，舒张期出现血流动力学异常，前向血流为一特征性表现，因此Doppler超声在静脉性勃起功能障百的诊断中具有一定价值。     

前列腺素E1乳膏对勃起功能障碍患者阴茎血流的影响

我院于2001年11月至2005年1月采用前列腺素E1（PGE1）乳膏经尿道内给药，使用彩色多普勒超声波显像仪观察了109例勃起功能障碍（ED）患者用药前后阴茎背动脉，左、右海绵体动脉峰值血流速度（PSV）和海绵体周径变化，报告如下。     

中药振阳煎对动脉性勃起功能障碍患者阴茎血流动力学的影响

目的:通过中药振阳煎对动脉性勃起功能障碍(ED)患者阴茎血流动力学的临床观察,探索对动脉性ED 患者有效的治疗方法。　方法:47例(40～49岁)动脉性ED患者,用中药振阳煎口服治疗1个月,治疗前后均采 用罂粟碱30mg+酚妥拉明1mg进行阴茎海绵体内注射(ICI),并运用双功能彩色多普勒超声检查治疗前后阴茎 左右海绵体动脉收缩期最大血流流率(PSV)。　结果:47例患者经中药振阳煎治疗后,左右两侧海绵体动脉PSV 明显改善(P<0.05)。　结论:中药振阳煎能明显改善动脉性ED患者的阴茎海绵体动脉血流,有效促进阴茎勃起。     

彩色多普勒超声检查在血管性勃起功能障碍诊断中的应用

目的 :探讨多普勒超声检查在诊断血管性勃起功能障碍 (ED)的临床价值。　方法 :应用多普勒超声检查阴茎药物诱导勃起前后的血液动力学改变 ,将非血管性ED病人与明确诊断血管性ED病人的多普勒超声变化进行对比 ,寻找血管性ED的特征。　结果 :动脉性ED病人深动脉的最大血流速度 (PSV)明显小于正常组 (P <0 .0 1) ;静脉性ED病人在阴茎完全勃起后背深静脉血流 (VV)仍大于对照组 (P <0 .0 5 )。　结论 :配合药物诱导阴茎勃起 ,多普勒超声检查是临床上筛选血管性ED的有效手段     

Different hemodynamic responses by color Doppler ultrasonography studies between sildenafil non-responders and responders

Aim： To determine if there are different penile hemodynamic patterns between sildenafil non-responders and responders by using color Doppler ultrasonography. Methods： A total of 69 erectile dysfunction （ED） patients aged 22-79 years were enrolled into the present study. Thirty-eight （55.1%） men with ED who did not respond to four attempts of treatment with 100 mg sildenafil after re-education were classified as sildenafil non-responders. A com- bination of three vasodilator drugs, 1.25 mg papaverine, 0.4 mg phentolamine and 5 ug prostaglandin E1, was given by intracavernous injection before penile Doppler ultrasonography was carried out. The erectile response to intracavernous injection and vascular parameters including peak systolic velocity （PSV）, resistance index （RI）, end diastolic velocity （EDV） and cavernosa artery diameter （CD） were measured and the results between sildenafil nonresponders and responders were compared. Results： No statistical difference in vascular parameters measured by Doppler ultrasonography studies between non-responders and responders was noted. Sildenafil non-responders had a poorer penile rigidity response to intracavernous injection than responders （P 〈 0.05）. Among patients with adequate PSV （〉 30 cm/s） and abnormal EDV （〉 5 cm/s）, individuals in the non-responder group had fewer positive responses to intracavernous vasodilator injection than in the responder group （35.3% vs. 72.2%, P 〈 0.05）. Advanced age and comorbidity with diabetes mellitus were significantly associated with sildenafil non-response （P 〈 0.05）. Conclusion： Sildenafil non-responders were characterized by a poorer penile rigidity response to intracavernous injection and had an associated impaired veno-occlusive mechanism. Advanced age and comorbidity with diabetes mellitus were two common factors associated with non-response.     

Relationship between penile hemodynamic parameters assessed by color Doppler ultrasonography and penile rigidity recorded by the RigiScan Plus

OBJECTIVE: We studied the relationship between penile hemodynamic parameters assessed by color Doppler ultrasonography and penile rigidity estimated by objective measurement. PATIENTS AND METHODS: A total 37 patients with erectile dysfunction were examined. After intracavernous injection of 20 microg prostaglandin E1, we measured their penile hemodynamic parameters in the cavernous arteries by color Doppler ultrasonography. Simultaneously, the RigiScan Plus device was used for real-time evaluation of penile rigidity. Hemodynamic parameters were correlated with penile rigidity. RESULTS: Peak systolic velocity and resistive index were significantly correlated with penile tip (r = 0.54, r = 0.72, respectively) and base (r = 0.55, r = 0.76, respectively) rigidity; there was no significant correlation between end-diastolic velocity and penile rigidity. CONCLUSIONS: Peak systolic velocity and resistive index were strongly correlated with penile rigidity in patients with erectile dysfunction during intracavernous pharmacological testing. The resistive index in particular appeared to be the most valid parameter for assessment of penile rigidity.     

Effectiveness of vardenafil versus papaverine in penile Doppler ultrasonography

PURPOSE: To evaluate erectile dysfunction, penile color Doppler ultrasound is currently considered the best method. But intracavernous injection is invasive and has adverse effects, such as prolonged erection and risk of priapism. In our study we want to evaluate whether vardenafil can be used instead of papaverine in penile Doppler ultrasonography. MATERIALS AND METHODS: A total of 24 patients with erectile dysfunction underwent color Doppler ultrasound before and after intracavernous injection of 60 mg papaverine with genital and audiovisual sexual stimulation. Peak flow and end diastolic velocity were measured in the recorded waveforms obtained 0, 1, 5, 10 and 20 min after injection. The patients also underwent color Doppler ultrasound after a 10-mg oral dose of vardenafil with genital and audiovisual sexual stimulation and at least 5 days after the prior examination. The same parameters were measured at 30, 45, 60, 75 and 90 min after the drug administration. We compared the results with the values obtained after papaverine injection. RESULTS: After oral vardenafil mean peak flow velocity significantly increased starting at 30 min and achieving a maximum value at 60 min. There were no significant differences in the 2 methods in mean peak velocity 1, 5, 10 and 20 min after papaverine injection, and 30, 45, 60, 75 and 90 min after oral vardenafil administration. Although papaverine injection is the gold standard for penile color Doppler ultrasound, it has severe adverse effects such as prolonged erection which we observed in 3 patients (12.5%) and required pharmacological detumescence. After vardenafil no severe adverse effects were observed. CONCLUSIONS: Vardenafil administration achieved increased peak flow velocity comparable to that after intracavernous papaverine injection. With no prolonged erection vardenafil is a safer alternative compared to more invasive intracavernous injection and is also an alternative for patients who fear injections.     

Objective penile vascular response to intraurethral prostaglandin E2 (dinoprostone)

PURPOSE: Intraurethral prostaglandin E2 (PGE2) administration is a noninvasive treatment modality for erectile dysfunction. The purpose of this study was to evaluate the objective effects of this agent by measuring peak systolic velocities of cavernosal arteries after intraurethral PGE2 administration and comparing with the results obtained with an intraurethral placebo gel and intracavernous papaverine injection. MATERIALS AND METHODS: The study group consisted of 22 consecutive impotent volunteers with a mean age of 46 years who had normal penile arterial responses as determined by penile arterial responses on papaverine-stimulated penile duplex ultrasonography. The peak systolic velocity in cavernosal arteries was recorded after intracavernous injection of 60 mg of papaverine. All patients received 1 mg of intraurethral PGE2 gel and placebo at 15-day intervals. The peak systolic velocities were recorded after each treatment. RESULTS: Mean peak systolic velocity achieved by intraurethral administration of PGE2 gel (25 +/- 8 cm/s) was less than that achieved by intracavernous papaverine (40 +/- 6 cm/s) but higher than that obtained by placebo (15 +/- 4 cm/s). Twelve patients had erections, while 9 had partial and 1 had no erection with intraurethral PGE2. Placebo did not cause any erections. No serious side effects were observed. CONCLUSION: Intraurethral administration of PGE2 appears to be an effective and simple method for increasing penile arterial flow and can be used during penile Doppler ultrasonography to stimulate the penile arterial system.     

A NEW METHOD FOR THE EVALUATION OF ERECTILE DYSFUNCTION: SILDENAFIL PLUS DOPPLER ULTRASONOGRAPHY

PURPOSE: Of the various methods of hemodynamic studies performed to evaluate erectile dysfunction penile color Doppler ultrasound is currently considered the best. However, intracavernous injection is invasive and has adverse effects, such as prolonged erection. We evaluated whether sildenafil may be used as a substitute for intracavernous agents when assessing impotence on color Doppler ultrasound. MATERIALS AND METHODS: A total of 42 patients with erectile dysfunction underwent color Doppler ultrasound before and after intracavernous injection of 60 mg. papaverine with genital and audiovisual sexual stimulation. Peak flow and end diastolic velocity were measured in the recorded waveforms obtained 0, 1, 5, 10 and 20 minutes after injection. The patients also underwent color Doppler ultrasound after a 50 mg. oral dose of sildenafil with genital and audiovisual sexual stimulation not before 3 days after the papaverine study. The same parameters were measured at 30, 45, 60, 75 and 90 minutes, and compared with the values obtained after papaverine injection. RESULTS: Mean peak flow velocity significantly increased after oral sildenafil starting at 30 minutes and achieving a maximum value at 60 minutes. There were no significant differences in the 2 methods in mean peak velocity 1, 5, 10 and 20 minutes after papaverine injection, and 30, 45, 60, 75 and 90 minutes after oral sildenafil administration. Penile color Doppler ultrasound with intracavernous papaverine injection is accepted as the gold standard but color Doppler ultrasound with sildenafil has 90% sensitivity and 100% selectivity for demonstrating arterial insufficiency. Due to prolonged erection 5 patients (11.9%) in the papaverine group required pharmacological detumescence by intracavernous injection. No adverse effects of sildenafil were observed. CONCLUSIONS: Sildenafil administration achieved increased peak flow velocity comparable to that after intracavernous papaverine injection. With no prolonged erection sildenafil emerges as a safer alternative compared to more invasive intracavernous injection.     

无创性动态阴茎海绵体测压诊断阴茎勃起功能障碍

目的　探讨应用无创性动态阴茎海绵体测压 (VISER)在勃起功能障碍 (ED)诊断中的价值。　方法　对 5 3例ED患者的PGE1阴茎海绵体内注射试验、VISER及彩色双功能超声检查结果进行对比分析。　结果　PorstⅢ级者 4 3例 ,平均海绵体压力和压力指数分别为 14 4 .2 9mmHg(1mmHg=0 .133kPa)和 1.2 4。 4 2例血管功能正常 ,1例为静脉性ED ;PorstⅡ级者 10例 ,平均海绵体压力和压力指数为 87.76mmHg和 0 .81,两组间比较差别有显著性意义 (P <0 .0 5 ) ;PorstⅡ级者中动脉性ED2例 ,静脉性ED8例 ,两组间海绵体压力比较差别有显著性意义 (P <0 .0 5 )。　结论　VIS ER是一种有效的无创性诊断ED的方法 ,对动脉性及静脉性ED的鉴别亦有一定价值。     

Usefulness of electromyography of the cavernous corpora (CC EMG) in the diagnosis of arterial erectile dysfunction

Electromyography (EMG) of the corpora cavernosa (CC-EMG) is able to record the activity of the erectile tissue during erection, and thus has been used as a diagnostic technique in patients with erectile dysfunction (ED). The present study examines the usefulness of the technique in the diagnosis of arterial ED. A cross-sectional study was made of 35 males with a mean age of 48.5 years (s.d. 11.34), referred to our center with ED for >1 year. The patients were subjected to CC-EMG and a penile Doppler ultrasound study following the injection of 20 μg of prostaglandin E1 (PGE1). The patients were divided into three groups according to their response to the intracavernous injection of PGE1: Group 1 (adequate erection and reduction/suppression of EMG activity); Group 2 (insufficient erection and persistence of EMG activity); and Group 3 (insufficient erection and reduction/suppression of EMG activity). Patient classification according to response to the intracavernous injection of PGE1 was as follows: Group 1: six patients (17%), Group 2: 18 patients (51%), and Group 3: 11 patients (31%). Patients diagnosed with arterial insufficiency according to Doppler ultrasound (systolic arterial peak velocity <30 mm s(-1) in both arteries) were significantly older than those without such damage (54.5 versus 41.8 years, respectively; s.d. 11.12). The patients in Group 3 showed a significantly lower maximum systolic velocity in both arteries than the subjects belonging to Group 2. Likewise, a statistically significant relationship was observed between the diagnosis of arterial insufficiency and patient classification in Group 3. The confirmation of insufficient erection associated with reduction/suppression of EMG activity showed a sensitivity of 66.7% (confidence interval between 50 and 84%) and a specificity of 92.9% (confidence interval between 84 and 100%) in the diagnosis of arterial ED. Owing to the high specificity of CC-EMG response to the injection of PGE1, this test is considered useful as a screening technique in the diagnosis of arterial ED.