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
References
- Konstantinides SV, Meyer G. The 2019 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. Eur Heart J. 2019; 40(3453): 3455.
- Rivera-Lebron B, McDaniel M, Ahrar K, et al. PERT Consortium. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin Appl Thromb Hemost. 2019; 25: 1076029619853037.
- Araszkiewicz A, Kurzyna M, Kopeć G, et al. Expert opinion on the creating and operating of the regional Pulmonary Embolism Response Teams (PERT). Polish PERT Initiative. Cardiol J. 2019; 26(6): 623–632.
- Sławek-Szmyt S, Jankiewicz S, Smukowska-Gorynia A, et al. Implementation of a regional multidisciplinary pulmonary embolism response team: PERT-POZ initial 1-year experience. Kardiol Pol. 2020; 78(4): 300–310.
- Raskob GE, van Es N, Segers A, et al. Hokusai-VTE investigators. Edoxaban for venous thromboembolism in patients with cancer: results from a non-inferiority subgroup analysis of the Hokusai-VTE randomised, double-blind, double-dummy trial. Lancet Haematol. 2016; 3(8): e379–e387.
- Giri J, Sista AK, Weinberg I, et al. Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association. Circulation. 2019; 140(20): e774–e801.
- De Gregorio MA, Guirola JA, Kuo WT, et al. Catheter-directed aspiration thrombectomy and low-dose thrombolysis for patients with acute unstable pulmonary embolism: Prospective outcomes from a PE registry. Int J Cardiol. 2019; 287: 106–110.
- Schmid P, Fischer AG, Wuillemin WA. Low-molecularweight heparin in patients with renal insufficiency. Swiss Med Wkly. 2009; 139: 438–452.
- Launay-Vacher V, Oudard S, Janus N, et al. Renal Insufficiency and Cancer Medications (IRMA) Study Group. Prevalence of Renal Insufficiency in cancer patients and implications for anticancer drug management: the renal insufficiency and anticancer medications (IRMA) study. Cancer. 2007; 110(6): 1376–1384.
- Givens ML, Wethern J. Renal complications in oncologic patients. Emerg Med Clin North Am. 2009; 27(2): 283–291.
- Cengiz K. Increased incidence of neoplasia in chronic renal failure (20-year experience). Int Urol Nephrol. 2002; 33(1): 121–126.
- Launay-Vacher V, Etessami R, Janus N, et al. Renal Insufficiency Anticancer Medications (IRMA) Study Group. Lung cancer and renal insufficiency: prevalence and anticancer drug issues. Lung. 2009; 187(1): 69–74.
- Launay-Vacher V, Gligorov J, Le Tourneau C, et al. Renal Insufficiency and Anticancer Medications (IRMA) Study Group. Prevalence of renal insufficiency in breast cancer patients and related pharmacological issues. Breast Cancer Res Treat. 2010; 124(3): 745–753.
- Launay-Vacher V, Ayllon J, Janus N. Drug management of prostate cancer: prevalence and consequences of renal insufficiency. Clin Genitourin Cancer. 2009; 7(3): E83–E89.
- Akl EA, Vasireddi SR, Gunukula S, et al. Anticoagulation for the initial treatment of venous thromboembolism in patients with cancer. Cochrane Database Syst Rev. 2011(4): CD006649.
- Shea-Budgell MA, Wu CMJ, Easaw JC. Evidence-based guidance on venous thromboembolism in patients with solid tumours. Curr Oncol. 2014; 21(3): e504–e514.
- Johansen KB, Balchen T. Tinzaparin and other low-molecular-weight heparins: what is the evidence for differential dependence on renal clearance? Exp Hematol Oncol. 2013; 2: 21.
- DeCarolis DD, Thorson JG, Clairmont MA, et al. Enoxaparin outcomes in patients with moderate renal impairment. Arch Intern Med. 2012; 172(22): 1713–1718.
- Cardiovascular Disease Educational and Research Trust, Cyprus Cardiovascular Disease Educational and Research Trust, European Venous Forum, International Surgical Thrombosis Forum, International Union of Angiology, Union Internationale de Phlébologie. Prevention and treatment of venous thromboembolism. International Consensus Statement (guidelines according to scientific evidence). Int Angiol. 2006; 25(2): 101–161.
- Mahé I, Aghassarian M, Drouet L, et al. Tinzaparin and enoxaparin given at prophylactic dose for eight days in medical elderly patients with impaired renal function: a comparative pharmacokinetic study. Thromb Haemost. 2007; 97(4): 581–586.
- Siguret V, Gouin-Thibault I, Pautas E, et al. No accumulation of the peak anti-factor Xa activity of tinzaparin in elderly patients with moderate-to-severe renal impairment: the IRIS substudy. J Thromb Haemost. 2011; 9(10): 1966–1972.
- Siguret V, Gouin-Thibault I, Pautas E, et al. No accumulation of the peak anti-factor Xa activity of tinzaparin in elderly patients with moderate-to-severe renal impairment: the IRIS substudy. J Thromb Haemost. 2011; 9(10): 1966–1972.
- Warkentin T, Greinacher A, Koster A, et al. Treatment and Prevention of Heparin-Induced Thrombocytopenia. Chest. 2008; 133(6).
- Siguret V, Pautas E, Février M. Elderly patients treated with tinzaparin (Innohep) administered once daily (175 anti-xa IU/kg): anti-xa and anti-iia activities over 10 days. Thromb Haemost. 2000; 84: 58–60.
- Jalal DI, Chonchol M, Targher G. Disorders of hemostasis associated with chronic kidney disease. Semin Thromb Hemost. 2010; 36(1): 34–40.
- Hirsh J, Warkentin TE, Shaughnessy SG, et al. Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest. 2001; 119(1 Suppl): 64S–94S.
- Garcia DA, Baglin TP, Weitz JI, et al. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl): e24S–e43S.
- Woodruff S, Feugère G, Abreu P, et al. A post hoc analysis of dalteparin versus oral anticoagulant (VKA) therapy for the prevention of recurrent venous thromboembolism (rVTE) in patients with cancer and renal impairment. J Thromb Thrombolysis. 2016; 42(4): 494–504.
- Monreal M, Trujillo-Santos J, Farge-Bancel D, Pedrajas JM, Gómez-Cuervo C, Ballaz A, Braester A, Mahé I. Comparison of Real-world Effectiveness and Safety of Enoxaparin versus Tinzaparin or Dalteparin in Cancer Patients with Venous Thromboembolism. The RIETECAT Cohort Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/comparison-of-real-world-effectiveness-and-safety-of-enoxaparin-versus-tinzaparin-or-dalteparin-in-cancer-patients-with-venous thromboembolism-the-rietecat-cohort-study/ (12.08.2021).
- Krasiński Z, Stępak H, Jawień A, et al. Safety of New Oral Anticoagulants for Patients with Chronic Kidney Disease. Curr Pharm Des. 2018; 24(38): 4505–4510.
- Farge D, Durant C, Villiers S, et al. Groupe Francophone Thrombose et Cancer (GFTC). Lessons from French National Guidelines on the treatment of venous thrombosis and central venous catheter thrombosis in cancer patients. Thromb Res. 2010; 125 Suppl 2: S108–S116.
- Venous thromboembolic disease NCCN guidelines V2.2009 . http://www.nccn.org/professionals/physician_gls/PDF/vte.pdf.
- Mandalà M, Falanga A, Piccioli A, et al. working group AIOM. Venous thromboembolism and cancer: guidelines of the Italian Association of Medical Oncology (AIOM). Crit Rev Oncol Hematol. 2006; 59(3): 194–204.
- Mandalà M, Falanga A, Roila F, et al. ESMO Guidelines Working Group, ESMO Guidelines Working Group. Management of venous thromboembolism in cancer patients: ESMO clinical recommendations. Ann Oncol. 2008; 19 Suppl 2: ii126–ii127.
![](https://journals.viamedica.pl/plugins/generic/popups/images/icons/close.png)