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Kho YY, Lee SHE, Chin K, Sidek NZ, Ma VC, Seng DH, Cai S, Tan LW, Teo SM, Gogna A, Patel A, Venkatanarasimha N. US of the Penis: Beyond Erectile Dysfunction. Radiographics 2024; 44:e230157. [PMID: 38814798 DOI: 10.1148/rg.230157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
High-frequency US, with a linear transducer and gray-scale, color, and spectral Doppler US techniques, is the primary imaging modality for evaluation of the penis. It can allow delineation of anatomy and assessment of dynamic blood flow; it is easily available and noninvasive or minimally invasive; it is cost effective; and it is well tolerated by patients. US assessment after pharmacologic induction of erection is an additional tool in assessing patients with suspected vasculogenic impotence, and also in selected patients with penile trauma and suspected Peyronie disease. Penile injuries, life-threatening infections, and vascular conditions such as priapism warrant rapid diagnosis to prevent long-term morbidities due to clinical misdiagnosis or delayed treatment. US can facilitate a timely diagnosis in these emergency conditions, even at the point of care such as the emergency department, which can facilitate timely treatment. In addition, color and spectral Doppler US are valuable applications in the follow-up of patients treated with endovascular revascularization procedures for vasculogenic erectile dysfunction. Image optimization and attention to meticulous techniques including Doppler US is vital to improve diagnostic accuracy. Radiologists should be familiar with the detailed US anatomy, pathophysiologic characteristics, scanning techniques, potential pitfalls, and US manifestations of a wide spectrum of vascular and nonvascular penile conditions to suggest an accurate diagnosis and direct further management. The authors review a range of common and uncommon abnormalities of the penis, highlight their key US features, discuss differential diagnosis considerations, and briefly review management. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Ying Ying Kho
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Sally Hsueh Er Lee
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Kenneth Chin
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Nur Zakiah Sidek
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Voon Chee Ma
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Dorothy Hkawn Seng
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Sihui Cai
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Lee Wei Tan
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Si Min Teo
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Apoorva Gogna
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Ankur Patel
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
| | - Nanda Venkatanarasimha
- From the Allied Health Division (Y.Y.K., S.H.E.L., N.Z.S., V.C.M., D.H.S., S.C., L.W.T., S.M.T.) and Division of Radiological Sciences (K.C., A.G., A.P., N.V.), Singapore General Hospital, 31 Third Hospital Ave, Singapore 168753
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Jamali M, Cherraqi A, Melang Mvomo A, Boukhlifi Y, Alami M, Ameur A. Thrombosis of the deep dorsal vein of the penis caused by vaccine-induced thrombotic thrombocytopenia: First reported case. Arab J Urol 2023; 21:36-39. [PMID: 36818370 PMCID: PMC9930863 DOI: 10.1080/2090598x.2022.2127236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The first described case of deep dorsal vein thrombosis of the penis secondary to vaccine-induced thrombotic thrombocytopenia (VITT), a complication of COVID adenoviral vector vaccines. The patient reported pain in the penis one month after vaccination. On ultrasound, a deep dorsal vein thrombosis was found and a biological workup was ordered to confirm the VITT trail. Anticoagulant therapy was immediately initiated and the patient responds well while suffering from erectile dysfunction. VITT is a potentially serious event that can be life-threatening; every practitioner should know how to deal with it.
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Affiliation(s)
- Mounir Jamali
- Urology Department, Mohammed V Military Hospital, Rabat, Morocco,CONTACT Mounir Jamali Urology Department, Mohammed V Military Hospital, Hay Ryad 10100 - Rabat, Morocco
| | - Amine Cherraqi
- Radiology Department, Mohammed V Military Hospital, Rabat, Morocco
| | | | | | - Mohammed Alami
- Urology Department, Mohammed V Military Hospital, Rabat, Morocco
| | - Ahmed Ameur
- Urology Department, Mohammed V Military Hospital, Rabat, Morocco
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Balawender K, Pliszka A, Surowiec A, Rajda S. COVID-19 infection as a new risk factor for penile Mondor disease. BMC Urol 2022; 22:57. [PMID: 35413893 PMCID: PMC9005161 DOI: 10.1186/s12894-022-01002-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/24/2022] [Indexed: 12/03/2022] Open
Abstract
Background Penile Mondor disease is a superficial dorsal vein thrombophlebitis of the penis, which mainly affects young and middle-aged men. It generally manifests as a visible painful cord located along the dorsal surface of the penis with signs of skin inflammation. The condition is usually self-limiting, but in severe cases a surgical procedure may be necessary in addition to pharmacological treatment. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is associated with a frequent incidence of thrombophilia; therefore, such a prothrombotic state during infection may be a significant risk factor for penile Mondor disease. Case presentation The 34-year-old patient reported moderate pain felt on the surface of the penis. During the medical interview, the patient did not admit significant risk factors for Mondor Disease, apart from the previous, a month earlier COVID-19 disease. Examination revealed swelling erythema and a thick indurated cord on the surface of the penis. Color Doppler ultrasound was performed to confirm assumptions and exclude thrombosis of other penile vessels. Based on visible clots in the course of the superficial penile vein and after exclusion of vasculitis due to autoimmune disease the diagnosis of penile Mondor disease was made. Pharmacological therapy was implemented to further break down the clot and prevent rethrombosis in the penile vessels. The patient did not report any treatment complications and returned for a control visit, which revealed complete clot dissolution on ultrasound; therefore, complete recovery was stated. Conclusions This case report presents the correlation between SARS-Cov-2 infection and penile Mondor disease, based on the confirmed influence of COVID-19 on the pathophysiology of thrombosis. It can be concluded that COVID- 19 is a risk factor for Mondor disease, as in the presented case the virus was the only prothrombotic risk factor for the patient. Consequently, the possibility of developing thrombosis in the form of penile Mondor disease should be taken into account among patients with post-COVID-19 and active SARS-Cov-2 infection.
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Affiliation(s)
- Krzysztof Balawender
- Clinical Department of Urology and Urological Oncology, Municipal Hospital in Rzeszow, Rycerska 4, 35-241, Rzeszow, Poland. .,Morphological Sciences Department, Institute of Medical Sciences, Medical College of Rzeszow University, Leszka Czarnego 4, 35-301, Rzeszow, Poland.
| | - Anna Pliszka
- Morphological Sciences Department, Institute of Medical Sciences, Medical College of Rzeszow University, Leszka Czarnego 4, 35-301, Rzeszow, Poland
| | - Agata Surowiec
- Morphological Sciences Department, Institute of Medical Sciences, Medical College of Rzeszow University, Leszka Czarnego 4, 35-301, Rzeszow, Poland
| | - Sebastian Rajda
- Morphological Sciences Department, Institute of Medical Sciences, Medical College of Rzeszow University, Leszka Czarnego 4, 35-301, Rzeszow, Poland
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