Evaluation of Penile Arteries with Color-Coded Duplex Sonography: Prevalence and Possible Therapeutic Implications of Connections Between Dorsal and Cavernous Arteries in Impotent Men

Abstract

Penile revascularization for cases of arteriogenic impotence is based on the assumption of hemodynamically relevant connections between the dorsal penile and cavernous arteries. In 325 clinically impotent patients color-coded duplex sonography was performed with the penis flaccid and tumescent after intracavernous injection of 10 micrograms prostaglandin E1. We measured peak flow velocity, end diastolic flow velocity and resistance in the dorsal arteries, deep cavernous arteries and connections perforating the tunica albuginea between the 2 systems. Of our patients 14% had at least 1 such anastomosis with a peak flow velocity exceeding 25 cm. per second after stimulation. Peak flow velocities less than 20 cm. per second were noted only in arteriogenically impotent patients, while those exceeding 25 cm. per second without later rigid erection occurred only in patients with venous occlusive dysfunction and end diastolic flow velocity exceeded 5 cm. per second. We conclude that penile revascularization should be contemplated only if hemodynamically relevant connections are detected, peak flow velocity in the cavernous arteries is less than 20 cm. per second and end diastolic flow velocity is less than 5 cm. per second.

Cavernosal arterial insufficiency is a major component of erectile dysfunction in some recipients of high-dose chemotherapy/chemo-radiotherapy for haematological malignancies

“…8 After injection of one or both of these agents, the diameter of the cavernosal arteries and peak systolic velocity can be used to predict the presence of arterial cause of erectile dysfunction. 8,9 It is not certain what cut-off between normal and abnormal blood flow must be used for the diagnosis of vasculogenic incompetence. Proposed values include 25, 30, 35 cm/s.…”

Fournier’s Gangrene: Viability Monitoring of SubcutaneouslyTransported Testis following Extensive Debridement by C olor-Coded Duplex Sonography and Nuclear Magnetic Resonance

“…Color-coded duplex sonography in urology is used to visualize the penile vascular system [4], to monitor testis perfusion after assumed testicular torsion as well as renal perfusion following renal transplantation. In our case it was used for the first time as a noninvasive technique that enables exact monitoring of the vitality of an impalpable testis awaiting repositioning into a neoscrotum.…”

Penile revascularization in vasculogenic erectile dysfunction (ED): long‐term follow‐up

“…Some preoperative diagnostic tests are recommended to increase the success rate of revascularization procedures, as selection of appropriate patients is of utmost importance in obtaining the best results [11]. Venous ligation, penile revascularization and implantation of penile prosthesis are treatment options for such patients, although each has its disadvantages.…”