Evaluation of Vasculogenic Erectile Impotence using Penile Duplex Ultrasonography

Abstract

A total of 140 patients underwent penile vascular evaluation with intracavernous papaverine injection combined with duplex ultrasonography. Of these patients 8 were potent men who were evaluated for reasons other than erectile failure. These potent men were used as controls to obtain normal values. The remaining 132 patients had erectile impotence of various etiologies. Real-time imaging with high resolution, high frequency probes allowed for visualization of the cavernous arteries along the entire length in addition to accurate measurement of the diameter. Simultaneous selectively focused Doppler ultrasonography was used to measure the blood velocity and other vascular parameters in the cavernous and dorsal arteries. Comparison of measurements before and after papaverine injection allowed for objective interpretation of the injection results. The results were analyzed and compared to other data available on the same patients, such as history and physical examination, nocturnal penile tumescence, penile blood pressures, selective arteriography and dynamic cavernosography. In addition to the 8 potent men, there were 35 patients (27% of the impotent patients) whose vascular findings were normal. A total of 78 patients (59% of the impotent patients) had arterial insufficiency; a subgroup of 13 patients had the pelvic arterial steal syndrome. Dynamic cavernosography confirmed venous leak in all 19 patients (14% of the impotent patients) whose penile duplex ultrasonography suggested the possibility of a venous leak. Ten patients (7%) had prolonged erection after papaverine injection and they were managed without consequences. One patient had a small hematoma that resolved uneventfully. Penile duplex ultrasonography was a helpful and objective method to evaluate vasculogenic impotence.

Imaging of the Lower Urinary Tract in Adults

“…30,31 Intracavernosal pharmacotherapy and new oral medications have enabled the medical treatment of impotence while facilitating diagnostic evaluation of the arterial inflow or veno-occlusive mechanism. A duplex ultrasound evaluation of the arterial inflow after pharmacotherapy has been used to describe the hemodynamic events with tumescence.…”

Color-Coded Duplex Sonography in Impotence: Significance of Different Flow Parameters in Patients and Controls

“…If that finding is borne out in humans, impaired penile blood flow in impo tence must be regarded as part of an underlying neurovas cular disease, and duplex sonography might serve as an indicator of that pathologic state. Therefore, we do not believe that the introduction of other flow parameters [15] or combination of parameters [16] will improve selectivity.…”

Comparison of one-side and bilateral intracavernosal papaverine injection on a Doppler study of the penis

“…7,[15][16][17][18] The artifactual difference between the PSV of the right and left cavernosal arteries that is produced by unilateral intracavernosal injection of a vasodilating agent in some patients may be in the nonsignificant range and does not interfere with the final diagnosis, but in some patients, it may interfere with the actual difference between the velocities of the right and left cavernosal arteries by adding to, or subtracting from, the actual difference between the two sides, which can exaggerate or mask the existing actual difference and affect the final diagnosis. It is probable that in a normal man with a higher velocity of the right cavernosal artery and a nonsignificant difference between the two sides, injecting the vasodilating agent into the right corpus cavernosum will result in an exaggeration of this difference and a false diagnosis of unilateral left side arterial insufficiency.…”