Colour Duplex Sonography in the Assessment of Impotence

Abstract

We present our experience with colour duplex sonography (Acuson 128) in the assessment of 83 impotent men. Cavernosal artery measurements were taken before and after the intracorporeal injection of papaverine. The peak velocities following papaverine injection correlated well with the degree of clinical response. Percentage diameter change corresponded with some groups of clinical erection grade, although it was not as good a discriminator as peak velocity. Twelve patients with 24 cavernosal arteries were also examined using pharmacological selective arteriography. Correlation between duplex sonography and arteriography showed an accuracy of 87.5%, specificity of 100.0% and sensitivity of 82.4%. All patients with a clinically good response following papaverine injection had peak bilateral cavernosal artery velocities greater than or equal to 25 cm/s. Amongst the remaining suboptimal responders, 18 also had this finding. Fifteen of these underwent pharmacological cavernosography and 14 exhibited venous leakage. Duplex sonography is a valuable and non-invasive tool in the assessment of impotence and can provide valuable information in deciding the course of further evaluation and treatment. The procedure was always completed more quickly with the guidance of colour Doppler.

Is sildenafil failure in men after radical retropubic prostatectomy (RRP) due to arterial disease? Penile duplex Doppler findings in 174 men after RRP

“…As in previous studies, we found the percentage change in CAD to be the least reliable parameter of arterial disease, because of the difficulty in measuring the small arterial CA diameters accurately and reproducibly. 24 A caveat of this study is the lack of control preoperative Doppler measurements, measurements in a cohort of sildenafil-responsive men, and men with normal erectile function after RRP. It is possible that, although the prevalence of arterial disease in this population was low, it might have been even lower pre-operatively.…”

“…The accuracy of penile Doppler in the determination of arterial disease has been established. 24,25 Arterial disease appears to be a major factor in non-RRP men failing sildenafil. 18 We therefore questioned whether this might be the case after RRP.…”

Adenosine modulation of neurotransmission in penile erection.

“…Nine patients also represented various other medical diseases, including diabetes in two, hypertension in three, myocardial infarction in one, parkinsonism in one, CVA in one and neurosis in one. The methods employed in the present study have been described in more detail in our previous work [17]. All patients were extensively informed about the study and the possible side effects and gave written informed consent.…”

Radiologic evaluation of penile arterial anatomy in arteriogenic impotence

“…Others have found that arteriographic examinations of the iliopudendal vascular system is improved after intracavernosal injection of a papaverine-phentoalamine drug combination. 12 Extremely anxious patients may not respond appropriately to a vasodilator, and additional sedation may be necessary to relieve some of the anxiety.…”