Peak systolic velocity thresholds of cavernosal penile arteries in patients with and without risk factors for arterial erectile deficiency

Prospective cross-sectional evaluation of penile helicine circulation by power doppler during dynamic ultrasound in veno-occlusive erectile dysfunction

OBJECTIVE

To evaluate the usefulness of Power Doppler to improve the diagnostic work up of veno-occlusive erectile dysfunction patients.

MATERIALS AND METHODS

Patients affected by erectile dysfunction, mean IIEF 5 = 13.5 (12-17) for at least 6 months, were enrolled in a prospective cross-sectional study. All patients underwent Dynamic Power Doppler after intracavernous injection of vasoactive drugs (PGE1 20 mcg and Papaverine 6 mg). Poor responders' patients subsequently underwent to cavernosometry to get a full assessment of the vascular framework.

RESULTS

202 patients (mean age 46 y.o.), were included in the study. 96 subjects (47.5%) who did not adequately respond to the intracavernous injection -test, subsequently underwent to cavernosometry. In 42/96 patients (43.7%) cavernosometry was positive for veno-occlusive dysfunction. In a total of 160 patients who did not have veno-occlusive dysfunction (54 with negative cavernosometry + 106 intracavernous injection-test responders), the Power Doppler was normal in 126 (78.8%) and pathological in 34 (21.3%) in terms of steric conformation of "low flow" vessels corresponding to the Cavernosal Terminal Unit. The diagnostic sensitivity of Power Doppler towards veno-occlusive dysfunction was found to be 52.4% (Positive Predictive Value: 39.3%), the specificity was 78.8% (Negative Predictive Value: 86.3%) and the total diagnostic accuracy was equal to 73.3%.

CONCLUSIONS

Collected data evidenced that patients who reported altered morphological features of the Cavernosal Terminal Unit had an approximately 4-fold greater risk of having veno-occlusive dysfunction compared to patients who had normal Power Doppler features (OR = 4.076; 95% CI: 1.996-8.327).

Li-Eswt improves hemodynamic parameters thus suggesting neoangiogenesis in patients with vascular erectile dysfunction

Extracorporeal treatment with low intensity shock-wave therapy (LI-ESWT) is a recently introduced non-invasive method which purposes the restoration of the pathophysiological alterations at the base of vasculogenic ED in male patients. The evidence in favour of the neoangiogenic potential of this treatment derived from in vitro studies and on animal models. The purpose of this study, in which the Power Doppler method was applied, is to demonstrate 'objectively' the real efficacy of LI-ESWT at the level of the microcirculation of the corpora cavernosa (neoangiogenesis) in patients affected by vasculogenic ED. Data from this study show, for the first time, that LI-ESWT treatment promotes neovascularisation of the functional arteries in patients affected by vasculogenic ED.

Diagnostic value of four-dimensional CT angiography in arterial erectile dysfunction using 320-detector row dynamic volume CT

The present study aims to evaluate the diagnostic value of four-dimensional CT angiography (4D-CTA) in the diagnosis of arterial erectile dysfunction (ED) using 320-detector row dynamic volume CT. Arterial ED patients attributed to arterial insufficiency were enrolled. To induce penile erection, an intracavernous injection (ICI) of corpus cavernosum with a vasoactive drug was administered. Patients were assigned into the erection hardness score (EHS) 1/2 group or EHS 3/4 group. Color duplex Doppler ultrasound (CDDU) was used to analyze blood flow spectrum. Each patient was examined using 4D-CTA. Receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic value of 4D-CTA in arterial ED. According to Irwin Goldstein, the EHS 3/4 group (n=38) had a shorter course of ED and low proportion with history of hypertension, hyperlipidemia, and diabetes than the EHS 1/2 group (n=35). The peak systolic velocity (PSV), end diastolic velocity (EDV), and resistant index (RI) in the EHS 3/4 group were lower than those of the EHS 1/2 group. 4D-CTA showed there were a total of 35 cases in the EHS 1/2 group (two cases missed) and 38 cases in the EHS 3/4 group (seven cases misdiagnosed). Using 4D-CTA to diagnose arterial ED, the area under the ROC curve yielded a value of 0.879, with a specificity of 93.9% and a sensitivity of 82.5%. These findings indicated that 4D-CTA using 320-detector row dynamic volume CT is a promising and reliable utility in diagnosing arterial ED.

Differences in Cavernosal Artery Parameters According to Different Anatomic Sampling Locations During the Diagnosis of Vascular Erectile Dysfunction Using Duplex Ultrasound

OBJECTIVE

To establish a standard location for examining penile cavernosal arteries (CAs) using dynamic duplex Doppler ultrasound (PDDU) examination in the diagnosis of non-arterial erectile dysfunction (ED) or arterial insufficiency.

PATIENTS AND METHODS

Two groups of 105 patients each were enrolled. The first group (age 56.3 ± 6.0 years) displayed clinical patterns of arterial insufficiency; the second group (age 35.2 ± 4.7 years) displayed clinical patterns of non-arterial ED. The patients had their peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI = PSV - EDV/PSV × 100), and acceleration time of the CAs measured using PDDU at the crura and at the midpoint between the penoscrotal junction and the coronal sulcus (mid penis). Intra- and interoperator variability were assessed. The PSV, RI, acceleration time, and EDV data obtained from the penoscrotal junction or from the "mid penis" in group 1 and in group 2 were compared using analysis of variance.

RESULTS

The PSV, EDV, and acceleration time were significantly higher when measured at the crura penis than when measured at the "mid penis" in both groups, whereas the RI was higher at the "mid penis" than at the "crura." Thus, arterial ED was better diagnosed with the data from the mid penis, whereas non-arterial ED was better diagnosed at the "crura."

CONCLUSION

The location of the sampling site of the CAs using PDDU is critical for a correct diagnosis of ED.