Variation in Penile Hemodynamics by Anatomic Location of Cavernosal Artery Imaging in Penile Duplex Doppler Ultrasound

Abstract

Introduction Standard operating procedures (SOP) for penile duplex Doppler ultrasound (PDDU) were published in 2013 to promote uniform vascular assessment for erectile dysfunction (ED). However, SOPs do not specify a standard anatomic location for cavernosal artery (CA) imaging. Aim The aim of this study was to determine the effects of CA imaging location on measured penile hemodynamics assessed by PDDU. Methods PDDU was performed in men with ED and/or Peyronie's disease. CA peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured at three points: the origin of the CA within the penile crus, the proximal CA, and mid-CA. Differences in PSV and EDV were assessed by Friedman test and categorical vascular outcomes by Fisher's exact test. Data were analyzed for the main cohort, the subgroup with maximal smooth muscle relaxation (SMR) as defined by negative EDV, and the subgroup with valid-for-intromission erections. Main Outcome Measures Mean PSV and EDV at three specified CA locations and the vascular diagnoses resulting from these measurements. Results One hundred four CAs were imaged in 52 men. Mean PSVs at the crus, proximal, and mid-CA were 52.9 ± 20.2, 29.5 ± 15.1, and 21.6 ± 10.6 cm/s, respectively (P < 0.0001); mean EDVs were 2.1 ± 8.9, 3.2 ± 5.4, and 3.3 ± 3.5 cm/s, respectively (P = 0.1225). The distribution of arteriogenic (P < 0.0001) and venogenic (P < 0.0001) diagnoses both differed significantly by location. Significant differences in vasculogenic diagnoses were also observed in the subgroup of CAs with definite maximal SMR (n = 38, arteriogenic P < 0.0001, venogenic P = 0.007) and in those with valid-for-intromission erections (n = 68, arteriogenic P < 0.0001, venogenic P = 0.0002). Conclusion There is large variability in measured PSV and EDV on PDDU depending on the site of Doppler imaging, which can often sway clinical diagnosis. Future guidelines should attempt to incorporate standard locations of CA imaging, and new normative values may be necessary for each location.

Penile doppler ultrasound predicts cardiovascular events in men with erectile dysfunction

“…Possible explanations might be multiple. As described by Pagano and Stahl (), the location of cavernous artery imaging appears to have a significant effect on the resulting measurement with more proximal measurements being significantly higher than those taken more distally. P‐DCU performed using alprostadil (PGE 1 ) probes the adenylated cyclase – cAMP pathway to induce erection and this is somehow independent from the endothelium mediated NO production.…”

Diagnostic Accuracy of Different Criteria of Pharmaco‐penile Duplex Sonography for Venous Erectile Dysfunction

“…About 5 to 10 minutes after injection, the sampling gate (size, 0.5 mm) was placed at approximately l to 2 cm from the origins of the bilateral cavernous arteries and their diameters measured, and the average was recorded . The spectrums of cavernosal arteries were observed repeatedly at the same sampling locations as mentioned above, respectively, taking care to keep the angle between the sampling line and the longitudinal axis of the blood vessel less than 60 degrees .…”

Is there a role for bilateral peak systolic velocity readings in a penile duplex ultrasound?

“…Although there is no generalised agreement on the interpretation of its results (Lee et al, 1993;Lue et al, 1985;Sikka, Hellstrom, Brock, & Morales, 2013) and there is also a known intra-and interobserver variation in its results (Pagano & Stahl, 2015), an effort has been made to develop standardised protocols for penile vascular assessment in ED (Sikka et al, 2013). The protocols aim to establish uniformity on examination and reporting, thus allowing better data interpretation and comparison.…”