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Penile Color Doppler Evaluation for Erectile Dysfunction
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Penile Color Doppler Evaluation for Erectile Dysfunction

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Dr Ho Siew Hong lectured at the Andrology Certification Workshop, 3rd Japan-ASEAN Men's Health and Aging Conference on 29 Nov 08

Dr Ho Siew Hong lectured at the Andrology Certification Workshop, 3rd Japan-ASEAN Men's Health and Aging Conference on 29 Nov 08

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Penile Color Doppler Evaluation for Erectile Dysfunction Presentation Transcript

  • 1. Penile Color Doppler Sonography in Erectile Dysfunction Dr Ho Siew Hong Consultant Urologist S H Ho Urology & Laparoscopy Centre Gleneagles Hospital
  • 2. Ultrasound and Color Doppler Sonography
    • B mode ultrasound - linear array of transducers simultaneously scans a plane - two-dimensional image
    • Doppler sonography - enhanced with Doppler effect - power Doppler for calculation of speed - color Doppler for direction
  • 3. Color Doppler Sonography
    • Structure
    • Diameter
    • Direction of flow
    • Velocity of flow (visual / audio)
  • 4. Penile Color Doppler Sonography in Erectile Dysfunction
    • Corpora cavernosa, corpus spongiosum, tunica albuginea
    • Hemodynamics of cavernosal arteries – before and after erection
  • 5. Vaculogenic ED
    • Organic ED 50-90%
    • Vasculogenic ED 50-70%
    • Arterial insufficiency
    • Venous incompetence / veno occlusive dysfunction / endothelial disease
    • Majority - mixed
  • 6. Why penile color doppler u/s ?
    • V/S penile arteriography or cavernosography / cavernosometry
    • All investigations require vasodilators
    • Less invasive - avoid cannulation of iliac vessels - avoid contrast exposure - avoid radiation exposure
  • 7. Indications for Color Doppler Sonography in ED
    • Excluded endocrine and neurological etiology
    • Failed trial of PDE 5 I
    • History suggestive of a. AV fistula b. veno occlusive dysfunction c. Peyronie’s disease
  • 8. Vascular anatomy of Penis
  • 9. Step 1
    • Homogenous corpora cavernosa, tunica albuginae
    • Areas of increased echogenicity – fibrosis or Peyronie’s
  • 10. Step 2
    • Pre-injection / flaccid state
    • Peak systolic velocity (PSV) > 10 cm/s
    • Measurement of cavernosal artery diameter – controversial and difficult to reproduce (0.3-10mm, increase by 75% or > 0.7mm)
  • 11. Step 3 - Injection of PGE E1
    • Measurement after 5 mins, mulitple measurements
    • Cavernosal arteries
    • Lower resistance arterial flow
    • Peak systolic velocity
    • PSV < 25-30 cm/s
    • Suggestive of arterial insufficiency
  • 12. Other systolic measurements
    • Mean of both left and right cavernosal artery readings
    • Systolic rise time
    • Intima thickness
  • 13. Step 4 – Diastolic measurements
    • Diastolic flow decreases with erection
    • End diastolic velocity decreases to zero and reverses
    • Persistent or EDV > 5 cm/s
    • Suggestive of venous leak
    • Absence of dilated veins
    • Most accurate in presence of normal arterial flow
  • 14. Step 5
    • Correlation of vascular abnormalities
    • Plaques with penile vessels
    • Location of AVF
  • 15. Complications
    • Pain – 20% severe, 30% moderate
    • Priapism – 10%
    • Ecchymosis – 5%
  • 16. Take home message
    • Penile Color Doppler U/S is not for every patient with suspected vasculogenic ED
    • ‘ Normal’ values are still not finalized
    • PSV and EDV stood test of time
    • May replace penile cavernosometry / cavernosography and arteriography in some circumstances
  • 17. Thank you