多普勒超声技术动态观察血管性勃起功能障碍患者阴茎血流动力学的变化

目的动态观察多普勒超声技术配合阴茎海绵体注射在血管性勃起功能障碍患者诊断中的价值。方法120例疑血管性ED患者在阴茎注射PGE1后5min、10min和20min应用多普勒超声技术测量阴茎血流动力学变化,指标包括:收缩期峰值流速(PSV)、舒张末期峰值流速(EDV)、血流阻力指数(RI)。另100例心因性ED设为对照组。第一次注射后勃起不佳的患者3d后增加PGE1剂量重新检测。结果120例患者可以观察到明显的血流动力学变化,其中有动脉性ED者34例,静脉性ED 55例,混合血管性31例。ICI后不同时间的多普勒测量其血流动力学变化有一定差异。结论多普勒超声技术诊断血管性勃起功能障碍有一定意义。阴茎海绵体注射药物后须动态观察阴茎血流动力学的变化。     

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。     

Value of power Doppler sonography in the investigation of erectile dysfunction.

OBJECTIVES: The poor sensitivity of conventional color-coded Doppler sonography (CCD) for low-flow signals limits its use for investigating patients with erectile dysfunction. Power Doppler sonography (PD) has recently been described for enhanced visualization of the microcirculation. Aim of this study was to determine the value of PD to demonstrate penile vascular pathophysiology as compared with conventional techniques. METHODS: 33 consecutive men with erectile dysfunction were investigated using the standard workup with conventional CCD and cavernosography before and after prostaglandin E(1) intracavernosal injection. Patients were subdivided into an arteriogenic, a venogenic, or a psychogenic group according to findings in the standard diagnostic workup. PD was used in addition to the standard protocol to demonstrate microcirculation, arterial blood flow, and venous leakage. The accuracy of the diagnosis obtained by PD and response to intracavernosal injection was compared with the clinical outcome in these groups at 6 months. RESULTS: PD was found to be superior to CCD in visualizing cavernosal microcirculation. In addition, arterial flow at basal peak systolic velocity was demonstrated in all patients with PD, whereas a signal sufficient for evaluation was obtained with CCD in only 69.7% (23/ 33). No significant difference in the maximal peak systolic velocity was noted using either PD or CCD. The positive predictive value of PD for venous leakage was poor (60%) when compared with cavernosography. PD used in conjunction with the response to intracavernosal injection was found to reliably predict the clinical outcome in the arteriogenic (p = 0.0007), the venogenic (p = 0.005), and the psychogenic group (p = 0.0002). CONCLUSIONS: Our data indicate that PD improves the evaluation of penile microcirculation and arterial function, but fails to reliably demonstrate venous leakage alone. Nevertheless, in most patients cavernosography could have been avoided by the aid of PD, since the underlying pathology can be calculated at a high predictive value without the need of further invasive tests. Therefore, with the aid of PD, the morbidity for patients being investigated for erectile dysfunction can be significantly reduced.     

High resolution ultrasonography and pulsed wave Doppler for detection of corporovenous incompetence in erectile dysfunction

Cavernosometry and cavernosography have been the primary modalities available for detection and mapping of corporovenous incompetence in patients with erectile dysfunction. These procedures are expensive, time-consuming and associated with some morbidity, prompting us to study a less invasive method, high resolution ultrasonography and pulsed wave Doppler ultrasound. We evaluated 13 patients with nonendocrinological, nonneurological erectile dysfunction by high resolution and Doppler ultrasound for flow in the dorsal and cavernosal veins after intracorporeal papaverine. All patients had a nonrigid response to papaverine and a mean maximum cavernous arterial systolic velocity of greater than 25 cm. per second. The 13 patients were subsequently studied by dynamic cavernosometry and cavernosography, which revealed evidence of venous incompetence (12 with dorsal venous leaks and 11 with cavernous venous leaks). Only 5 of the 12 patients with dorsal venous incompetence had flow detected in the dorsal vein by ultrasound and Doppler studies. High resolution and Doppler ultrasound was unable to detect leakage in the cavernous veins. Among the 2 groups of patients with dorsal venous leaks (those with and without flow detectable by Doppler ultrasound) there was no significant difference in mean cavernous artery diameter or mean cavernous arterial maximum velocity. Similarly, there was no significant difference between the 2 groups in induction, maintenance or initial decompression rates on cavernosometry. We conclude that high resolution and Doppler ultrasound cannot replace dynamic cavernosometry and cavernosography as the diagnostic modality for venous incompetence.     

The actual incidence of papaverine-induced priapism in patients with erectile dysfunction following penile colour Doppler ultrasonography

Penile color Doppler sonography is a valuable method for evaluating erectile dysfunction. However, there are some concerns about the safety of this method due to the intracorporeal pharmacological injection, which may cause priapism as a complication, resulting in penile fibrosis. To evaluate the actual incidence of papaverine-induced priapism in patients with erectile dysfunction (ED) who underwent penile colour Doppler sonography and to determine the safety of this diagnostic tool, a retrospective study was conducted using the database of our institution. A total of 672 men with ED underwent penile color Doppler ultrasonography with the intracorporeal injection of 60 mg papaverine hydrochloride. The patient characteristics of priapism cases were retrospectively evaluated. Priapism in 18 of the 672 patients (2.68%) was successfully treated with blood aspiration, irrigation and injection of an α-agonist medication, when needed. Patients with priapism were younger compared with those without priapism; mean age 45 ± 12.51 (20–68) versus 50.93 ± 12.04 (17–78) ( P  < 0.001). Penile Doppler ultrasound is a safe procedure in evaluating erectile dysfunction. The incidence of priapism, which is the most important complication of this procedure, is low and can be managed successfully with conservative approaches.     

超声造影技术在静脉性勃起功能障碍诊断中的应用

目的:探讨超声造影技术用于静脉性ED诊断的有效性及安全性。方法:2015年6月至2016年3月在南京鼓楼医院泌尿男科通过阴茎海绵体造影确诊为阴茎海绵体静脉漏患者23例、无阴茎海绵体静脉漏患者20例,43例患者行阴茎海绵体活性药物注射+超声造影检查。结果:23例阴茎海绵体静脉漏患者中21例在超声造影过程中显示明显静脉漏,准确率为91.3%;其中双静脉漏型12例,单静脉漏型2例,阴茎脚静脉漏型5例,海绵体混合型静脉漏2例。2例超声造影未见静脉漏,与阴茎海绵体造影结果不相符。20例无阴茎海绵体静脉漏患者2例超声造影见静脉漏,与阴茎海绵体造影结果不相符。结论:超声造影技术诊断静脉性ED具有一定准确性;超声造影技术用于静脉性ED的诊断具有创伤小,安全性高等优点。     

药物性阴茎双功能超声在勃起功能障碍诊断中的应用

对１２４例勃起功能障碍（ＥＤ）者应用药物性阴茎双功能超声（ＰＰＤＵ）检查评估阴茎海绵体动脉功能和静脉关闭机制。结果显示：非血管性ＥＤ者８５例（６８５４％），动脉性ＥＤ者４例（３２３％），静脉性ＥＤ者３５例（２８２３％）。认为ＥＤ患者应常规行ＰＰＤＵ检查。     

Doppler evaluation of erectile dysfunction - part 1

Erectile dysfunction (ED) is the consistent inability to achieve and maintain an erection sufficient for satisfactory sexual activity. Erectile dysfunction affects as many as 30 million men in America, with an increasing prevalence with age. Erectile dysfunction is secondary to organic, psychogenic and combined causes. The first part of this review article describes the guidelines for evaluation and treatment plans for men with ED. It also describes the normal sonographic anatomy of the penis, sonographic technique for evaluation of ED and the normal phases of erection.     

Significance of phentolamine redosing during prostaglandin E1 penile color Doppler ultrasonography in diagnosis of vascular erectile dysfunction

Recently, it was reported that phentolamine redosing during penile duplex can abolish a false diagnosis of venous leakage in patients with impotence. The aim of this study is to identify any useful role of phentolamine redosing in diagnosis of venogenic impotence. Sixty-seven consecutive patients complaining of weak erection for at least 6 months were included in this study. Penile color Doppler ultrasound (CDU) was performed using a 7.5 MHz linear array transducer with a color flow mapping capability. Following intracavernous injection of 20 microg prostaglandin E1 (PGE1), all patients with persistent end diastolic velocity (EDV) >5 cm/sec with an erectile response of E3 or lower, 20 min after intracavernosal injection of PGE1, were asked to revisit our clinic for a second CDU, 2 weeks later. During initial CDU examination, all 67 patients experienced poor response to 20 microg PGE1 with their average peak systolic velocity (PSV) and EDV being 42.8 and 6.6 cm/sec, respectively. The second CDU examination had similar results to the first one. Addition of 2 mg phentolamine did not significantly change the PSV and EDV of cavernosal arteries in any of the 67 patients. In conclusion, addition of intracavernous phentolamine during PGE1 CDU examination carries no advantage over the use of PGE1 alone regarding cavernosal artery response in patients with suspected venogenic EDV.     

Doppler evaluation of erectile dysfunction - part 2

Doppler evaluation in erectile dysfunction (ED) has a significant role in determining the cause of ED. The advantages of penile Doppler and pharmacologic duplex ultrasonography include objective, minimally invasive evaluation of penile hemodynamics at a relatively low cost. Arteriogenic ED may be secondary to peripheral vascular disease and diabetes, or may be seen in association with coronary artery disease. Various parameters, such as diameter of the cavernosal artery, peak systolic flow velocity, degree of arterial dilatation and acceleration time, have been suggested for the diagnosis of arteriogenic ED, but peak systolic flow velocity is the most accurate indicator of arterial disease. This second part of the review article describes the various causes of ED and the interpretation and evaluation of color flow Doppler examination in ED.     

Clinical implications of power Doppler three-dimensional ultrasonography

Power Doppler ultrasonography displays an estimate of the entire power contained in that part of the received radiofrequency ultrasound signal for which a phase shift corresponding to the motion of the target is detected. In contrast, conventional color Doppler imaging displays Doppler frequency shift information. Few reports have been published on the clinical utility of three-dimensional power Doppler ultrasonography in vascular patients. This study analyzed our experience of the clinical utility of this technology. Fifty-three patients selected out of 281 who were referred to our vascular laboratory underwent both conventional color duplex ultrasonography and power Doppler ultrasonography for the following indications: the question of subtotal versus total arterial occlusion, tortuous artery with limited imaging on color duplex ultrasonography, the presence of significant disease by Doppler ultrasonography with limited imaging, deep-lying arteries with an obscure orifice (e.g., renal artery), and heavily calcified arteries. The power Doppler ultrasonography portion of the examination was considered of positive diagnostic value if the final impression was different from that of conventional color duplex ultrasonography. A positive diagnostic value was achieved in 22 of 29 (76%) carotid artery examinations, 10 of 14 (71%) peripheral artery examinations, 4 of 5 (80%) renal artery examinations, and 3 of 5 (60%) aortoiliac examinations. Overall, positive diagnostic value was achieved by adding power Doppler ultrasonography in 39 of 53 patients (74%). Five of six patients (83%) who were felt to have carotid occlusion by color duplex ultrasonography were confirmed to have subtotal occlusion by power Doppler ultrasonography. Similarly, 6 of 8 patients (75%) with questionable subtotal versus total peripheral arterial occlusion by color duplex ultrasonography were confirmed to have subtotal occlusion by power Doppler ultrasonography. Four of five patients' (80%) renal examinations had a positive diagnostic value, which included three patients in whom the orifice of renal arteries was not seen by color duplex ultrasonography. Three-dimensional power Doppler ultrasonography can be more readily applied to clinical practice. Power Doppler ultrasonography is capable of defining the severity or extent of vascular disease, particularly in differentiating subtotal from total arterial occlusion.     

Colour Doppler sonography of flaccid penis in evaluation of erectile dysfunction

BACKGROUND: Erectile dysfunction is a common and potentially treatable problem. Other than psychological, anatomical and metabolic factors, vasculogenic causes also play an important role in erectile dysfunction. Among the various diagnostic tools available for the diagnosis of vasculogenic causes, colour Doppler sonography is noninvasive, simple and promising. METHODS: This preliminary prospective study was conducted on 40 patients with erectile dysfunction, coming from a rural background to a hospital situated in a semi-urban setting. RESULTS: It was found that a cut-off value of 10 cm/second for peak systolic velocity in flaccid penis had the best accuracy among three chosen cut-off values, i.e. 5, 10, 15 cm/second, for detecting arterial insufficiency with sensitivity of 94.1%, specificity of 93.6%, negative predictive value of 98% and positive predictive value of 80%. CONCLUSION: Doppler sonography may be used as a good predictor of clinical response to intracavernosal injection of a vasodilating pharmacological agent.     

Clinical value of scrotopenogram for evaluating varicocele and erectile dysfunction.

While there is as yet no established theory regarding a possible relationship between varicocele and erectile failure, it is not uncommon to encounter those cases in which two conditions coexist clinically. We describe a new technique to identify these two conditions by a single injection of radioisotope. In scrotopenogram, varicocele is diagnosed by comparing the radioactivity in each hemiscrotum during the five minutes after injection of radioisotope. Then, after the patient is exposed to audiovisual sexual stimulation, the dynamic penile flow is measured for the next thirty minutes. We evaluated 185 impotent patients and 9 patients with varicocele. In the 185 erectile failure patients, varicoceles were also present in 33 (17.8%). In the 9 patients who presented themselves chiefly with varicoceles, 3 (33.3%) also had erectile failure. Thus, in 194 patients 36 (18.5%) cases of combined conditions were identified by the scrotopenogram technique. We believe this new technique could be an alternative method for noninvasively examining impotent patients with varicoceles.     

The value of testing pudendal nerve conduction in evaluating erectile dysfunction in diabetics

We conducted an open prospective study on the value of testing pudendal nerve conduction (PNC) in 45 diabetic and 32 nondiabetic men with documented erectile dysfunction (ED) of at least six months duration. All subjects underwent PNC by the same investigator using the Medcelec/TECA Sapphire device with calibration parameters of sweep 10 ms/div an amplitude of 200 microV/div. No statistically significant differences was found in the mean bulbocavernosus reflex (BCR) latencies between the nondiabetics (33.6 ms/div +/- 4.1) and the diabetics (37.5 ms/div +/- 9.1) (P > 0.05). Our results show that electrophysiological measurement of the BCR in diabetics is not a useful diagnostic test and emphasize the importance of a multifactorial evaluation of diabetic ED.     

Testicular torsion: Usefulness of contrast-enhanced power Doppler sonography

A 13-year-old-boy with suspected left testicular torsion was referred to our institute. During preparation, a significant decrease of signals on the left testis was found, however, slight blood flow was detected by the ultrasound examination enhanced by Levovist. As a result of the examination we left the testis intact, although the color of the testicular parenchyma remained black. One year after the surgery, an ultrasound examination was done again and good vascurality was observed.