Radiologic evaluation of penile arterial anatomy in arteriogenic impotence

Abstract

Functional and anatomic evaluation of penile arterial blood¯ow is essential in the work up of erectile dysfunction. Duplex ultrasonography is an ideal screening modality with cavernosal mean peak systolic blood¯ow velocity being the most sensitive predictor of arterial disease. Arterial variability of the penis may affect sonographic evaluation leading to frequent misinterpretation and therefore pudendal arteriography remains the current gold standard for penile arterial evaluation. Appreciation of the type and frequency of anatomic variants and potential collateral routes is important in interpreting penile arteriograms and in evaluating the hemodynamic signi®cance of suspected arterial disease.

Review: The vascular system and erectile dysfunction in diabetes — the role of penile Doppler

“…During erection, the artery dilates to approximately 1 mm in size. 12 Peak systolic velocity (PSV) and end diastolic velocity (EDV) are recorded sequentially for 30 minutes. A normal cavernosal artery waveform is shown in figure 1.…”

“…[14][15][16][17][18] It is now generally accepted that PSV >35 cm/s predicts normal arterial inflow and that PSV <25 cm/s is a predictor of arterial insufficiency. 12,16 Several alternative arterial waveform parameters have been suggested to predict arterial insufficiency in the intermediate PSV range (25-35 cm/s) including 'systolic rise time', 19 and acceleration time ({PSV -EDV} / systolic rise time). 17 Figure 2 shows characteristic features of cavernosal arterial insufficiency in a patient with arteriogenic ED.…”

“…For example, distal perforator branches may lead to the spuriously low flow recorded in the proximal cavernosal artery at the base of the penis. 12 The introduction of power Doppler imaging may help to overcome this problem. The reproducibility of penile Doppler results has been questioned, 27 highlighting the importance of maximal smooth muscle relaxation during the examination.…”

Sonographic diagnosis of penile Mondor's disease associated with absence of a dorsal penile artery

“…Occasionally, they also contribute to tumescence of corpus cavernosum via perforating vessels. 7 Variations of the penile arterial vascular supply are common. Chiou et al described the asymmetry of dorsal arteries, in which 1 artery is well developed, while the other is small, or even atrophic.…”

A Study on Penile Doppler

“…In our study 13(25%) patients were smoker, among smokers 8(61%) patients had vasculogenic ED, compare to 5(38%) patients with non vasculogenic ED Table 4 & (Graph 4). Furthermore, our study highlights the potential interaction of buergers disease with ED [11][12][13][14][15]. Buerger disease was present in 5(9.6% patients) all of them were smokers and 4 out of 5 (80%) were suffering from vasculogenic ED.…”