Prostate vascular flow: The effect of the ejaculation on the power doppler ultrasonographic examination

Abstract

Power Doppler sonography (PD) can accurately depict tissue perfusion, recognize slow flows, and is relatively angle independent. The monitoring of local blood flow by Doppler ultrasonography is helpful in differentiating prostatic physio-pathological conditions, but the recognizing of physiological variables that could affect it is crucial to apply this technique in clinical practice. This study aimed to evaluate if ejaculation affects blood flow to the prostate and to state how long this effect lasts. Serial PD examinations of prostate were performed in 18 dogs (1-5 years, 6-40 kg) immediately before (T0) and after (T1) the ejaculation, and repeated 6 (T2), 18 (T3) and 24 (T4) hours later. For each examination, two representative PD images were chosen and ranked by two independent observers according to the following scoring system: 0 = mild subcapsular (S) vascularization without clear evidence of parenchymal (P) vascularization; 1 = moderate P and S vascularization; 2 = severe S and moderate P vascularization; 3 = severe P and moderate S vascularization; 4 = severe P and S vascularization. Interobserver agreement was assessed using Kappa of Cohen. Ranked data, grouped according to time, were compared by ANOVA and Tukey HSD test (p < .05). Variations in the vascular flow pattern at different times were observed for all dogs. The statistical analysis evidenced a significant difference for T0 vs T1 and vs T2 and vs T3 (p < .01), with no significant difference for T0 vs T4 (p > .05). Interobserver agreement was very good (Kappa of Cohen = 0.86). This study demonstrated a definite increase in vascular flow to the prostate after ejaculation. The present results suggest a minimum of 24 hr sexual rest before the PD examination of the gland. This result should be taken into account whenever Doppler sonography is used to evaluate potential hyperaemia in dogs suspected of having prostate abnormalities.

Canine prostate specific esterase (CPSE) as an useful biomarker in preventive screening programme of canine prostate: CPSE threshold value assessment and its correlation with ultrasonographic prostatic abnormalities in asymptomatic dogs

“…In clinical veterinary practice, the most commonly used methods to diagnose canine prostatic gland diseases are digital rectal examination and abdominal ultrasound (Mantziaras et al, 2017;Mukaratirwa & Chitura, 2007;Newell et al, 1998). Recently some authors suggested that the monitoring of local blood flow by Doppler or Contrast-Enhanced UltraSonography (CEUS) is helpful in differentiating prostatic physio-pathological conditions (Alonge, Melandri, Fanciullo, Lacalandra, & Aiudi, 2017;Bigliardi & Ferrari, 2011;Russo, Vignoli, & England, 2012;Troisi et al, 2015). Cytological evaluation by fine-needle aspiration or biopsy of the prostate is usually performed to confirm the benign nature of the prostate volume enlargement (Davidson & Baker, 2009;Kraft, Brown, & LeRoy, 2005;Levy et al, 2014;Paclikova, Kohout, & Vlasin, 2006).…”

Ejaculation Effect on Canine Prostatic Specific Esterase Serum Concentration

“…In dogs, it was recently reported that ejaculation induces an increase in the vascularisation of the prostate gland [34][35][36][37]. Augmented prostatic vascular flow can be detected up to 24 h after ejaculation by Power Doppler [34], which is very accurate for slow flows [36].…”

“…It can be hypothesized that, as reported in human medicine regarding PSA [20], during its transportation, CPSE can enter into the systemic circulation and its increase might be due to a CPSE wash-back into the bloodstream. Particularly, while pelvic muscles and peri-prostatic tissue contractions of ejaculation may increase the leakage of PSA [31] and CPSE into the bloodstream, the increased vascular bed revealed at the ultrasonographic examination [34,35] drives the biomarkers to the systemic circulation.…”

Ejaculation effect on blood testosterone and prostatic pulsed‐wave Doppler ultrasound in dogs

“…The increased vascular prostatic flow is detectable up to 24 hr after ejaculation by Power Doppler (Alonge et al., ), which is very accurate in recognizing slow flows (Zelli et al., ). Pulsed‐Wave, more specific for high flows, is instead altered for at least 6 hr.…”

“…Testosterone, promoting androgenic‐receptor‐mediated tissue growth and stimulating angiogenesis and vascular growth (Franck‐Lissbrant, Haggstrom, Damber, & Bergh, ), must be considered among parameters possibly affecting prostatic vascularization. In the recent past, the role of ejaculation on prostatic vascular appearance on Power Doppler exam was assessed (Alonge, Melandri, Fanciullo, Lacalandra, & Aiudi, ) in order not to misdiagnose the prostatic neovascularization occurring during glandular disorders (Freitas et al., ; Newell et al., ; Polisca et al., ; Zelli et al., ). The present study aimed to evaluate whether and how ejaculation and blood testosterone affect prostatic Pulsed‐Wave exam and to state how long this effect lasts.…”