Erectile dysfunction: the role of penile Doppler ultrasound in diagnosis

Abstract

Erectile dysfunction (ED) is a common and debilitating condition with physical, psychological, and pharmacological aetiologies. The physical causes can be divided into problems with arterial inflow, structural penile abnormalities, or problems with the venous occlusion mechanism. Penile Doppler sonography is a specialized technique requiring a thorough knowledge of the topic in order to aid diagnosis and direct subsequent treatment. This technique is indicated in those patients with erectile dysfunction who do not respond to oral pharmacological agents (e.g., PDE-5 inhibitors). This pictorial essay will visit the anatomy and physiology of penile erection, the technique for performing the procedure, and review the imaging features for specific causes of ED.

Penile Doppler Ultrasound in Men with Stuttering Priapism and Sickle Cell Disease—A Labile Baseline Diastolic Velocity Is a Characteristic Finding

“…In the healthy male, penile blood flow in the flaccid state is at a low level because of a high sinusoidal smooth muscle tone, with equal low level blood inflow and outflow. On PDU, low velocity inflow is only seen during systole with either no or negative flow during diastole [8,9]. This is the characteristic Doppler velocity pattern of a high PR tissue bed.…”

“…On PDU, this increase in blood flow secondary to smooth relaxation is seen as a manifold increase in cavernosal artery blood velocity, and a characteristic velocity and Doppler waveform evolution can be observed [8,9], reflecting the changes in cavernosal artery velocity and peripheral vascular resistance that occur as the corporal smooth Table 1 Clinical findings in nine men with stuttering priapism secondary to sickle cell disease Table 2 Median velocities as measured on penile Doppler ultrasound in men with stuttering priapism and sickle cell disease (SCD) compared with those with Peyronie's disease, erectile dysfunction (ED), and normal erectile function . This signifies that the smooth muscle and the distal vascular tone are high.…”

“…On PDU, this increase in blood flow secondary to smooth relaxation is seen as a manifold increase in cavernosal artery blood velocity, and a characteristic velocity and Doppler waveform evolution can be observed [8,9], reflecting the changes in cavernosal artery velocity and peripheral vascular resistance that occur as the corporal smooth muscles first relax, followed by engorgement of the cavernosal sinusoids, culminating in full penile erection. Pre‐erection, the systolic velocity is low, the diastolic velocity is zero, and the waveform has a damped or high PR shape.…”

Penile Arterial Waveform Analyzer for Assessing Penile Vascular Function in Young Adults

“…16 On the other hand, although the Rigiscan is regarded as a reliable tool in assessment of erectile function since 1985, 4,9,24 it requires an erectile penis the rigidity of which may vary with the degree of stimulation and also with the psychological status. 21 In addition, the popularity of clinical application of Duplex sonography in the assessment of penile vasculature 17,22 is also hampered by the costly equipment and the need for a well-trained operator. Moreover, the clinical application of other techniques proposed in the 1990s including plethysmography, PPG, and pulse volume recording has not yet been validated.…”

“…5,6,30,31 Preliminary clinical evaluation of ED includes a detailed history-taking and an assessment of serum testosterone level. On the other hand, although a number of assessment tools of penile hemodynamics including Penile Brachial Index (PBI), plethysmography, photoplethysmography (PPG), pulse volume recording, 10,12,27,32,34 Rigiscan, 4,9,24 and Duplex sonography 17,22 have been proposed, their popularity is restricted either by limited sensitivity or a high cost of the equipment. The development of a clinically easyto-operate and reliable investigative tool, therefore, is needed for the evaluation of penile vascular integrity to guide appropriate medical or surgical treatments.…”