Penile Color Doppler Evaluation for Erectile Dysfunction

22,090 views

Published on

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

2 Comments
30 Likes
Statistics
Notes
No Downloads
Views
Total views
22,090
On SlideShare
0
From Embeds
0
Number of Embeds
34
Actions
Shares
0
Downloads
0
Comments
2
Likes
30
Embeds 0
No embeds

No notes for slide

Penile Color Doppler Evaluation for Erectile Dysfunction

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

×