Penile Doppler sonographic and clinical characteristics in Peyronie's disease and/or erectile dysfunction: an analysis of 1500 men with male sexual dysfunction

Abstract

Study Type – Therapy (cohort) Level of Evidence 4 What's known on the subject? and What does the study add? Penile colour Doppler ultrasonography (CDU) can be an invaluable investigative tool to characterize penile abnormalities to complement clinical history and physical examination in the evaluation of men with Peyronie's disease (PD) and/or erectile dysfunction (ED). Although CDU findings between men with PD and those with ED were not markedly different, subtle differences were observed. The classic penile CDU findings in men with PD comprise tunical thickening, intracavernosal fibrosis, septal fibrosis and intracavernosal calcification, while, in men with ED, low peak systolic velocity and high end‐diastolic velocity are found on penile haemodynamics. Previously published studies have focused predominantly on either ED or PD exclusively, or examine the risk of progression to ED in the PD population. To our knowledge, this is the largest and most comprehensive analysis of penile CDU and clinical findings in men with PD and/or ED. The large sample size and multivariable analysis allow meaningful interpretation of the results. This study has found some substantial differences in the penile CDU findings of men with PD and/or ED that have not previously been reported. Although the risk factors of ED may be greater than those for PD, there is crossover in age, cardiovascular risk factors, trauma and penile CDU findings in men with PD and/or ED. OBJECTIVE To explore the differences in penile colour Doppler ultrasonography (CDU) findings between men with Peyronie's disease (PD) and those with erectile dysfunction (ED). MATERIALS AND METHODS Patients presenting with PD and/or ED who underwent penile CDU were recruited to the study. Patient demographics, comorbidities, International Index of Erectile Function‐5 scores, previous therapies and physical findings were documented. Penile curvature, presence of tunical thickening, septal fibrosis, intracavernosal fibrosis and calcification, and cavernosal vascular status were recorded. RESULTS A total of 1500 men underwent penile CDU during the 10‐year period. Of these men, 891 men presented with PD and 609 men had ED only. Men with ED had higher rates of diabetes and coronary artery disease (P < 0.05). Isolated tunical thickening was more common in older men and in the PD cohort. The presence of intracavernosal fibrosis correlated strongly with difficulty maintaining erection (P < 0.05). Impaired cavernosal arterial flow was observed in men with decrease penile rigidity and penile pain, while higher end‐diastolic velocities were found in men with difficulty maintaining erection and tunical thickening on penile CDU. CONCLUSIONS Men with PD and ED had many similarities and differences on penile CDU. Penile CDU continues to be an invaluable clinical tool in the management of men with male sexual dysfunction.

Penile Artery Shunt Syndrome: A Novel Cause of Erectile Dysfunction after Penile Revascularization Surgery

“…Additionally, all preoperative diagnostic studies (penile duplex ultrasound, dynamic infusion cavernosometry, and pelvic angiography) confirmed isolated left cavernosal arterial insufficiency without venous leak. By duplex ultrasound, the left PSV was 14.6 cm/second, which is within the range of <25 cm/second strongly associated with decreased penile rigidity in large cohort studies [5].…”

AlgaEcklonia bicyclis,Tribulus terrestris, and Glucosamine Oligosaccharide Improve Erectile Function, Sexual Quality of Life, and Ejaculation Function in Patients with Moderate Mild-Moderate Erectile Dysfunction: A Prospective, Randomized, Placebo-Controlled, Single-Blinded Study

“…Arteriogenic ED or arterial insufficiency is diagnosed when PSV is <25 cm/s, with angiographic correlation showing that a PSV threshold of 25 cm/s has 92% accuracy in diagnosis of arterial integrity. Penile CDU represents an accurate tool to investigate cavernous artery inflow and venous leakage frequently used for assessing the efficacy of several genitourethral reconstruction surgical techniques, in patients who underwent urethroplasty, peyronie's disease related surgery, or penile revascularization [27, 28]. …”

Evaluation of the benefit of using a combination of autologous platelet rich-plasma and hyaluronic acid for the treatment of Peyronie’s disease

“…PRP rich in growth factors and other compounds initiates a reconstructive process in TA, whose global effects are visible through echographic controls. Although widely used for diagnostic purpose [24,25], US technique is very specific to this proposed technique of treatment with two advantages. First, it allows taking precise measurements of the whole albuginea, providing comparison data all along the procedure.…”