Vol 1, No 1 (2003)
Review paper
Published online: 2003-09-18
Duplex sonography in erectile dysfunction diagnosis
Seksuologia Polska 2003;1(1):39-43.
Abstract
Duplex sonography of the penis was introduced to the medical practice by Lue et al. in 1985. It was possible
after discovery that intracavernosal injection (ICI) of papaverine resulted in complete erection. The
doppler technique measures velocity of blood flow in the cavernosal arteries during artificially inducted
erection. The examination should be performed in comfortable conditions.
The vasomotor agents are injected into the corpus cavernoosum. Adequate response is being observed after injecting 20-40 mg papaverine or 5-20 mg prostaglandin E1 (PGE1). Papaverine and PGE1 are potent smooth muscle relaxants that act directly on the deep penile arteries. To demonstrate deep penile arteries the corporal bodies should be scanned in the transverse and sagittal planes from base to the tip of the penis. Spectral analysis of doppler waveform in the cavernosal arteries enables measurement of peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) calculated from the formula RI = (PSV - EDV)/EDV.
PSV after ICI of vasodilatating agent is the most helpful parameter to evaluate arteriogenic impotence. The level of PSV in deep penile artery less than 25 cm/s is a strong evidence of arterial inflow disease. If arterial insufficientie is excluded, excessive venous leakage is the most probable source of erectile dysfunction. EDV exceeding 7 cm/s is characteristic for men with veno-occlusive disorders. There is also a group of patients with mixed type of ED with coegsisting arterial inflow insufficiency and excessive venous leakage.
The vasomotor agents are injected into the corpus cavernoosum. Adequate response is being observed after injecting 20-40 mg papaverine or 5-20 mg prostaglandin E1 (PGE1). Papaverine and PGE1 are potent smooth muscle relaxants that act directly on the deep penile arteries. To demonstrate deep penile arteries the corporal bodies should be scanned in the transverse and sagittal planes from base to the tip of the penis. Spectral analysis of doppler waveform in the cavernosal arteries enables measurement of peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) calculated from the formula RI = (PSV - EDV)/EDV.
PSV after ICI of vasodilatating agent is the most helpful parameter to evaluate arteriogenic impotence. The level of PSV in deep penile artery less than 25 cm/s is a strong evidence of arterial inflow disease. If arterial insufficientie is excluded, excessive venous leakage is the most probable source of erectile dysfunction. EDV exceeding 7 cm/s is characteristic for men with veno-occlusive disorders. There is also a group of patients with mixed type of ED with coegsisting arterial inflow insufficiency and excessive venous leakage.
Keywords: duplex sonographyerectile dysfunction
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