Peak Systolic Velocity Of Cavernosal Arteries Research Articles

(313) Low-Intensity Extracorporeal Shockwave Therapy May Result in Improvements in Flaccid Cavernosal Artery Peak Systolic Velocity

Abstract Introduction Low-intensity extracorporeal shockwave therapy (LiESWT) is thought to treat erectile dysfunction (ED) by stimulating neovascularization and nerve regeneration. Studies suggest subjective improvements following treatment, but objective measures are sparse. Objective We aimed to objectively assess the efficacy of LiESWT in the treatment of ED using penile Doppler in men with ED following LiESWT therapy. We hypothesized that LiESWT results in demonstrable increases in penile blood flow. Methods Patients were prospectively enrolled in a clinical trial examining objective and subjective changes in erectile function following LiESWT. Patients underwent baseline examination with penile Duplex ultrasound in both the flaccid and rigid states following intracavernosal injection of alprostadil. Patients received 12 bi-weekly LiESWT treatments of 0.2mJ/mm2 at 5Hz, 1500 shocks delivered per treatment, with follow up Duplex at 1-2 weeks, 4-6 weeks, 3 months and 6 months post-treatment. Highest peak systolic velocity (PSV) and lowest end diastolic velocity (EDV) were reported. Results Twenty-five patients completed all five study visits. The mean highest PSV in the flaccid state prior to treatment was 7.86 cm/s (± 1.47), which significantly increased to 11.31 cm/s (± 1.81, p < 0.05) immediately following completion of treatments. This increase was sustained at 4-6 weeks with a mean PSV of 12.74 cm/s (± 1.80, p < 0.05), followed by 10.74 cm/s (± 1.43, p < 0.05) at 3 months, and 9.87 cm/s (± 1.14, p=0.11) at 6 months (Figure 1). No significant improvements were noted in flaccid lowest EDV or rigid peak PSV/lowest EDV. Conclusions Our results suggest that LiESWT may improve baseline penile vascularity. Overall, the clinical significance of the noted improvement in flaccid PSV after LiESWT remains to be determined and more work needs to be done to define the mechanism of action of LiESWT at a tissue level in human subjects. Disclosure No.

Erect penile low intensity shockwave therapy (LiSWT): Vascular and erectile tissue health changes pre- and post-treatment

ABSTRACT Introduction In 2010, low-intensity shockwave therapy (LiSWT) was first described for used on the flaccid penis as a novel and minimally invasive regenerative treatment for men with ED. A standardized protocol for use of LiSWT either in the flaccid or erect state has not yet been established. Erect penile LiSWT, in contrast to flaccid penile LiSWT, is performed with maximal penile shaft blood volume under conditions of greatest acoustic impedance. This minimizes transfer of shockwave energy though the erectile tissue enabling the greatest uptake of shockwave energy to the erectile tissue. We review our experience with LiSWT during pharmacologic erection. Objective Assess arterial blood flow and erectile tissue health parameters in ED patients prior to and following erect penile LiSWT to better document the hypothesized vascular/erectile tissue regenerative benefits associated with LiSWT in men with ED. Methods A retrospective chart review was performed. Prior to LiSWT (Urogold 100 MTS). ED patients underwent a baseline penile Grayscale/Doppler ultrasound (G/DUS) with Grade 3-4/4 erection following appropriate visual/pharmacologic stimulation. A B-mode ultrasound (Aixplorer 15.4 MHz transducer) was then performed at specific settings to avoid reader bias. This included 12 total axial images obtained at proximal, midshaft and distal dorsal penis at a fixed dynamic range of 70 dB with B-mode gain values of increased brightness (45%, 55%, 65%). The fourth image at each axial location was taken at a dynamic range of 49 dB and a B-mode gain value identified as providing the best discrimination between Grayscale black/white. Subsequently, in the erect shaft right/left sagittal planes, cavernosal artery peak systolic velocity (PSV) and end diastolic velocity (EDV) values were obtained. ED patients then underwent 6 erect penile LiSWT treatments over varying intervals. The protocol included: appropriate visual/pharmacologic stimulation to obtain Grade 3-4/4 erection, 600 shocks using a parabolic reflector probe (OP-155), energy flux density 0.13mJ/mm2, 3 Hz, membrane pressure 3, applied each to dorsal, ventral, right/left lateral erect penile shafts, and right/left erect crura (total shocks 3600, duration of LiSWT ∼ 28 minutes). Patients returning for erect penile LiSWT completed a PGI-I score. Approximately one month after the last erect penile LiSWT, a post-treatment penile G/DUS with Grade 3-4/4 erection was repeated resulting in 24 Grayscale images. Baseline and post-treatment G/DUS were de-identified and read by two experts reaching consensus concerning erectile tissue homogeneity/inhomogeneity where Grayscale (0/3) was consistent with no inhomogeneity; (1/3) mild inhomogeneity (<25% of cross-sectional area revealing hypo- or hyper-echoic regions), (2/3) moderate inhomogeneity (25% - 50%), and (3/3) severe inhomogeneity (>50%), respectively. In addition, PGI-I scores were assessed and compared to ultrasound findings Results A total of 79 patients (mean age 44 +/- 21, range 19 – 85) met inclusion criteria. A total of 53/79 (67%) had improved erectile tissue homogeneity post-LiSWT from baseline, 10/79 (13%) were unchanged, 15/79 (19%) worsened. Of the 53 patients with improved G/DUS findings, 40/53 patients (75%) rated PGI-I as improved. 37/53 (70%) patients had PSV increase and 18/53 (34%) had EDV decrease. Conclusions The mechanisms by which erect penile LiSWT improves erectile function, in part, involve enhanced erectile tissue homogeneity, increased cavernosal arterial PSV and decreased EDV. Disclosure Work supported by industry: no.

Vascular and Erectile Tissue Health Changes Pre- and Post- Low Intensity Shockwave Treatment of the Erect Penis

ABSTRACT Introduction In 2010, low-intensity shockwave therapy (LiSWT) was first described for used on the flaccid penis as a novel and minimally invasive regenerative treatment for men with ED. A standardized protocol for use of LiSWT either in the flaccid or erect state has not yet been established. Erect penile LiSWT, in contrast to flaccid penile LiSWT, is performed with maximal penile shaft blood volume under conditions of greatest acoustic impedance. This minimizes transfer of shockwave energy though the erectile tissue enabling the greatest uptake of shockwave energy to the erectile tissue. We review our experience with LiSWT during pharmacologic erection. Objective Assess arterial blood flow and erectile tissue health parameters in ED patients prior to and following erect penile LiSWT to better document the hypothesized vascular/erectile tissue regenerative benefits associated with LiSWT in men with ED. Methods A retrospective chart review was performed. Prior to LiSWT (Urogold 100 MTS). ED patients underwent a baseline penile Grayscale/Doppler ultrasound (G/DUS) with Grade 3-4/4 erection following appropriate visual/pharmacologic stimulation. A B-mode ultrasound (Aixplorer 15.4 MHz transducer) was then performed at specific settings to avoid reader bias. This included 12 total axial images obtained at proximal, midshaft and distal dorsal penis at a fixed dynamic range of 70 dB with B-mode gain values of increased brightness (45%, 55%, 65%). The fourth image at each axial location was taken at a dynamic range of 49 dB and a B-mode gain value identified as providing the best discrimination between Grayscale black/white. Subsequently, in the erect shaft right/left sagittal planes, cavernosal artery peak systolic velocity (PSV) and end diastolic velocity (EDV) values were obtained. ED patients then underwent 6 erect penile LiSWT treatments over varying intervals. The protocol included: appropriate visual/pharmacologic stimulation to obtain Grade 3-4/4 erection, 600 shocks using a parabolic reflector probe (OP-155), energy flux density 0.13mJ/mm2, 3 Hz, membrane pressure 3, applied each to dorsal, ventral, right/left lateral erect penile shafts, and right/left erect crura (total shocks 3600, duration of LiSWT ∼ 28 minutes). Patients returning for erect penile LiSWT completed a PGI-I score. Approximately one month after the last erect penile LiSWT, a post-treatment penile G/DUS with Grade 3-4/4 erection was repeated resulting in 24 Grayscale images. Baseline and post-treatment G/DUS were de-identified and read by two experts reaching consensus concerning erectile tissue homogeneity/inhomogeneity on Grayscale with 0/3 no inhomogeneity, 1/3 mild inhomogeneity (<25% of cross-sectional area revealing hypo- or hyper-echoic regions), 2/3 moderate inhomogeneity (25% - 50%), and 3/3 severe inhomogeneity (>50%), respectively. PGI-I scores were also assessed and compared to ultrasound findings. Results 79 patients (mean age 44 +/- 21, range 19 – 85) met inclusion criteria. 53/79 (67%) had improved erectile tissue homogeneity post-LiSWT from baseline, 10/79 (13%) were unchanged, 15/79 (19%) worsened. Of the 53 patients with improved G/DUS findings, 40/53 patients (75%) rated PGI-I as improved. 37/53 (70%) patients had PSV increase and 18/53 (34%) had EDV decrease. Conclusions The mechanisms by which erect penile LiSWT improves erectile function, in part, involve enhanced erectile tissue homogeneity, increased cavernosal arterial PSV and decreased EDV. Disclosure No

Diagnostic categorization of erectile dysfunction using duplex color doppler ultrasonography and significance of phentolamine redosing in abolishing false diagnosis of venous leak impotence: A single center experience.

Background and Aims:Erectile dysfunction (ED) is an inability to achieve and maintain erectile rigidity sufficient for satisfactory sexual performance. It is either organic or psychogenic in origin. This study was aimed at establishing vasculogenic causes among patients being evaluated for ED using Penile Doppler Ultrasound.Methods:Fifty-two consecutive patients with the clinical diagnosis of ED were evaluated with color Doppler ultrasound scan using a 7.5 MHz high-frequency linear transducer between July 2016 and June 2019. The examination was commenced 3 min after an intracavernosal injection with 10-20 μg of PGE1 and continued for 30 min. The measurements were obtained alternately from both deep penile arteries. The variables analyzed were the peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI), calculated as (PSV-EDV)/PSV. Erection Hardness was evaluated subjectively using the EH Score (EHS), a 5-point response score denoting how the patient would rate his erection. ED was subjectively assessed using the International Index of Erectile Function (IIEF-5) questionnaire. In patients with a diagnosis of vasculogenic ED, intracavernosal PGE1 injection was started with a 5 μg dose and then increased in 5 μg increments until the final dose of 20 μg was reached.Results:PSV of cavernosal arteries (CA) varied between 19.2 and 106.2 cm/s (mean: 43.8 ± 18.2) among the entire patients and between 19.7 and 80.2 cm/s (mean: 42.6 ± 11.3) among patients with arteriogenic ED. Arteriogenic ED was found in 8 patients (15.3%), while venogenic ED was observed in 12 patients, which constituted 23% of the entire study population and mixed arteriogenic-venogenic ED was found in 6 patients (11.5%) of the study population. DICC performed on patients diagnosed with venogenic ED on color Doppler ultrasonography revealed venous leakage and no statistically significant differences between results of DICC and color Doppler ultrasonography were found in EDV, RI, and PI measurements (P< 0.005). Among patients with venogenic ED and mixed arteriogenic-venogenic ED,2 patients had a normal erectile response and the remaining 16 received 2 mg phentolamine. A significant increase in PSV between baseline and 20 mg PGE1 (P < 0.001) was observed in all cases. Following phentolamine, there was a significant increase in grade of erection (P = 0.0001) and a significant reduction in the EDV (P = 0.0001). A reduction of the EDV to below 0.0 cm/s was observed in 12 patients. In patients with arteriogenic erectile dysfunction, mean (±standard deviation) duration of erection for consecutive doses of PGE15 μg, 10 μg, 15 μg, and 20 μg were 42.2±18.4, 55.4±24.1, 66.1 ± 31.1, and 83.3±36.7 minutes, respectively, with significant increase for each dose. In patients with veno-occlusive dysfunction, mean durations of erection significantly increased from 9.1±8.0 minutes at 10 μg to 19.2±9.8 minutes at 20 μg.Conclusion:In the current study, 50% of patients had vasculogenic ED and “false-positive’’ diagnosis of venous leakage was unmasked by phentolamine re-dosing. It is therefore imperative that patients with ED benefit from duplex color Doppler ultrasonography which is safe, cheap and non-ionizing diagnostic modality before initiating therapy as ED treatment is cause specific.

Cavernosal artery peak systolic velocity among normal adults in Abuja, Nigeria: A Baseline parameter for sonographic diagnosis of vasculogenic erectile dysfunction

Background: Erectile dysfunction is consistent inability to achieve and maintain erection of sufficient rigidity for satisfactory sexual performance. It is well known that the hemodynamic function of the penis correlates well with the peak systolic velocity (PSV) of the cavernosal artery (CA) which is the most reliable, sensitive, and objective parameter used in evaluating the state of the erectile tissues of the penis. This study was aimed at establishing the normal CA PSV in this environment, as it may differ from the values among Americans, Caucasians, and Asians. Materials and Methods: The study was conducted between July 2015 and January 2017, at the Department of Radiology, Federal Medical Centre, Abuja. Twenty-nine consecutive patients referred by the urologist to the radiology department of the aforementioned institution for penile ultrasound were evaluated using triplex Doppler sonography with high-frequency linear array transducer. The penile scan was done before and after intracavernosal injection of 10–20 μg prostaglandin E1. The waveforms of CAs were obtained alternately using the angle of inclination ≤60°, and the PSV of the CA was documented at 5-min interval, from 5 to 40 min. Results: PSV of CA varied between 26 and 104.4 cm/s (mean: 46.72 ± 16.21) among the entire research participants. No significant discrepancy was noted between PSV of the right and left cavernosal arteries. The PSV had a strong positive relationship with age (P = 0.002), with the highest values found among those ≤30 years. Conclusion: The mean PSV of cavernosal arteries established in this study is not significantly different from the values obtained among Americans, Caucasians, and Asians, indicating that racial difference has no effect on this important sonographic variable.

The Effect of Testosterone Replacement Therapy on Penile Hemodynamics in Hypogonadal Men With Erectile Dysfunction, Having Veno-Occlusive Dysfunction.

Hypogonadism may cause veno-occlusive dysfunction (VOD) by structural and biochemical alterations in the cavernosal tissue. The aim of the study was to investigate the effect of testosterone replacement therapy (TRT) on penile hemodynamics in hypogonadal men with erectile dysfunction and VOD.The study included 32 hypogonadal men with erectile dysfunction, having VOD. All patients underwent penile color Doppler ultrasonography (PCDU) at the beginning and 6 months after the initial evaluation. Erectile function was evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5); hypogonadism was evaluated by testosterone measurement and the Aging Male Symptoms (AMS) scale. All patients received transdermal testosterone 50 mg/day for 6 months. Clinical and radiological findings were compared before and 6 months after the TRT.The mean age was 58.81 ± 4.56 (52–69) years. Mean total testosterone levels were 181.06 ± 39.84 ng/dL and 509.00 ± 105.57 ng/dL before and after the therapy, respectively (p < .001). While all patients had physiological serum testosterone levels (>320 ng/dL) after the therapy, three cases (9.3%) had no clinical improvement of hypogonadism symptoms. Cavernosal artery peak systolic velocity (PSV) and resistive index (RI) significantly increased, and end diastolic velocity (EDV) significantly decreased after TRT. VOD no longer existed in 21 (65.6%) of the cases.This study demonstrated that TRT may restore penile hemodynamics in hypogonadal men with VOD.

MP91-18 THE ROLE OF VACUUM ERECTION DEVICES IN PENILE REHABILITATION AFTER POSTERIOR URETHRAL ANASTOMOTIC URETHROPLASTY:A PILOT STUDY

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I1 Apr 2017MP91-18 THE ROLE OF VACUUM ERECTION DEVICES IN PENILE REHABILITATION AFTER POSTERIOR URETHRAL ANASTOMOTIC URETHROPLASTY:A PILOT STUDY Lujie Song and Qiang Fu Lujie SongLujie Song More articles by this author and Qiang FuQiang Fu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2858AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess the efficacy and safety of vacuum erection devices(VED) for the penile rehabilitation in patients with pelvic fracture urethral distraction defects (PFUDD) who underwent posterior urethral anastomotic urethroplasty. METHODS This prospective study consisted of 60 patients who underwent successfully primary bulboprostatic anastomosis with a perineal approach and developed erectile dysfunction following surgery between Jan 2012 and Jun 2015. The patients were randomized to VED combined with Tadalafil (10mg) once every two days (Group 1, n=28) or Tadalafil (10mg) once every two days (Group 2, N=32) for 6 months. The International Index of Erectile Function-5(IIEF-5), nocturnal penile tumescence (NPT) testing and dynamic color-duplex Doppler ultrasonography (D-CDDU) was used as the evaluation tools. Assessments were made at 2 time points: 1 month and 7 months after urethroplasty. RESULTS The mean patient age was 31.4±7.0 years (Group 1) and 33.3±7.2 years (Group 2) repectively (p>0.05). No patients ended the penile rehabilitation program because of treatment-related adverse events in both groups. In Group 1, 57.1% (16/28) patients have erections sufficient to finish the vaginal intercourse compared to 46.9% (14/32) in Group 2 at 7 months after urethroplasty. At 7 months after urethroplasty, the IIEF-5 score is (16.5±4.0) and (13.6±4.3) respectively in Group 1 and Group 2 (p<0.05). According to D-CDDU, the cavernosal artery peak systolic velocity (PSV) is (37.1±7.4) cm/second and (31.6±9.7) cm/second (p<0.05), the cavernosal artery end diastolic velocity(EDV) is (4.1±0.9) cm/second and (4.2±1.2) cm/second (p>0.05), and the penile length change is (3.1±0.9) cm and (2.4±0.9) cm(p<0.05) respectively in Group 1 and Group 2 after drug injection. NPT testing shows that the number of erectile events is (2.4±2.0) and (2.8 ±1.7) (p>0.05), the duration of erectile events is (12.1 ±4.1) min and (11.5±4.7)min (p>0.05), and the penile Avg Event Rigidity is (26.9±10.2) cm and (26.4±11.6) cm (p>0.05)respectively in Group 1 and Group 2. CONCLUSIONS This short term study showed that early use of VED is useful and well-tolerated in the penile rehabilitation for the patients after posterior urethral anastomotic urethroplasty because of PFUDD. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1224-e1225 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Lujie Song More articles by this author Qiang Fu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Penile Doppler ultrasound predicting cardiovascular disease in men with erectile dysfunction.

Cardiovascular disease is a major cause of morbidity and mortality in the USA. Traditional risk factors such as obesity, physical inactivity, and diet are used to screen for cardiovascular disease. However, these risk factors miss a significant population who are at risk for future cardiac events. Erectile dysfunction (ED) has many associated conditions in common with cardiovascular disease and has been shown to be an independent risk factor for cardiovascular. Measurements made on penile Doppler ultrasound (PDU), such as cavernosal artery peak systolic velocity (PSV), cavernosal artery intima-medial thickness, and the finding of cavernosal artery calcification, are indicators of generalized vascular disease. Thus, elements of PDU can identify men at higher risk for cardiovascular disease. This review outlines the proper technique for PDU and the literature supporting the use of PDU to predict cardiovascular disease in men with erectile dysfunction.

Only the Nose Knows: Penile Hemodynamic Study of the Perineum–Saddle Interface in Men with Erectile Dysfunction Utilizing Bicycle Saddles and Seats with and without Nose Extensions

To investigate the differential impact of straddles (A(ns) and B(ns)) and noseless two-cheek seats (A(ntcs) and B(ntcs)) on penile hemodynamics and perineal compressive forces in subjects who cycle in a stationary bicycle. Subjects underwent cavernosal artery peak systolic velocity (CAPSV) measurements after intracavernosal injection of vasoactive agents while supine, sitting upright on an examination table, straddling a saddle, sitting on a seat, and again supine. Mean perineal compression pressures recorded while straddling the saddles were compared with those while sitting upright. No differences were found in right and left CAPSV values while supine, sitting upright on an examination table, sitting on a seat, and supine again. Right/left CAPSV (cm/second) values straddling A(ns) and saddle B(ns) (0.7 +/- 2.9/1.5 +/- 6.2 and 0/0, respectively) were significantly lower than values obtained while sitting on A(ntcs) and B(ntcs) (25.6 +/- 13.4/23.8 +/- 12.0 and 17.3 +/- 6.4/18.3 +/- 6.5, respectively) (P < 0.001). Mean perineal compression pressures (mm Hg) on A(ns) and saddle B(ns) (315.2 +/- 39 and 387.9 +/- 64.3, respectively) were significantly higher than values obtained while sitting upright on an examination table (47.6 +/- 5.2 and 46.0 +/- 8.1, respectively) (P < 0.001). We have identified an objective test to assess if an individual bicycle rider, sitting on a certain shape of bicycle saddle or seat generates sufficient compressive forces at the perineal-saddle interface to obstruct cavernosal arterial inflow. This study also demonstrated that straddling bicycle saddles with nose extensions is associated with perineum-saddle interface compressive pressures that exceed systolic perfusion pressures, significantly diminishing penile hemodynamics.

Correlation between penile duplex findings and stress electrocardiography in men with erectile dysfunction.

The aim of this work is to assess the association between vasculogenic erectile dysfunction (ED) and coronary artery disease in men above the age of 40 y. The study included 40 patients above 40 y of age with vasculogenic ED of more than 3 months duration. A dynamic duplex study after intracavernosal injection of a bimix solution (60 mg papaverine + 2 mg phentolamine mesylate) was carried out using a color ultrasound machine. The patients underwent a stress ECG test, carried out on a motor-driven treadmill according to the 'Bruce Protocol'. A total of 12 patients were diagnosed with positive ischemic heart disease (IHD). Their mean peak systolic velocity (PSV) was PSV = 19.58 cm/s. In all, patients were diagnosed with negative IHD; their mean PSV was 36.21 cm/s. A statistically significant difference was observed between patients with positive IHD and patients with negative IHD regarding PSV (P = 0.003). The sensitivity of a PSV of less than 35 cm/s in predicting IHD was 50% with a specificity of 100%. Positive predictive value for abnormal stress ECG to predict a PSV of less than 35 cm/s was 100%. In conclusion, the PSV of cavernosal arteries is a reliable measure for predicting IHD in patients with vasculogenic ED. Patients with a PSV of less than 35 cm/s should be referred for cardiologic assessment as they carry a real risk of having silent IHD.

Correlation of Penile Duplex Ultrasonography, PBI, DICC and Angiography in the Diagnosis of Impotence

The results of different vascular tests used in the diagnosis of cavernosal arterial insufficiency and cavernosal venous leakage were compared in 168 men, with an average age of 62.9 y to determine which were the most reliable. One hundred and forty-five men had penile arterial insufficiency demonstrated with digital subtraction pharmacoangiography. The penobrachial index correctly identified 87 of the 145 men with penile arterial insufficiency whereas cavernosal artery peak systolic velocity identified 130 men and cavernosal artery occlusion pressures identified 136 men. Ninety-six men had cavernosal venous leakage demonstrated during dynamic infusion cavernosometry and cavernosography. The correlation between maintenance flow rate (Qm) and cavernosal pressure decay rate during pressure loss cavernosometry (dccp) was good (R = 0.95). The Resistance Index (RI) calculated during cavernosal duplex ultrasonography determined 15 min after vasodilator challenge corrected identified 93 out of 96 venous leakers and 68 of the 72 non-venous leakers. However, the Resistance Index (RI) determined 5 min after vasodilator challenge whilst correctly identifying all 96 venous leakers, identified only 5 of the 72 non-venous leakers and incorrectly categorising the remaining 67 non-leakers as having venous leakage. In conclusion, both the peak systolic velocity and cavernosal artery occlusion pressure are accurate predictors of cavernosal artery insufficiency, whereas the penobrachial index is a poor predictor. Cavernosal duplex ultrasonography appears as reliable as angiography, is less invasive and more cost effective. The RI is an accurate predictor of cavernosal venous leakage only if determined once maximal response to vasodilator challenge has occurred.

Correlation of penile duplex ultrasonography, PBI, DICC and angiography in the diagnosis of impotence.

The results of different vascular tests used in the diagnosis of cavernosal arterial insufficiency and cavernosal venous leakage were compared in 168 men, with an average age of 62.9 y to determine which were the most reliable. One hundred and forty-five men had penile arterial insufficiency demonstrated with digital subtraction pharmacoangiography. The penobrachial index correctly identified 87 of the 145 men with penile arterial insufficiency whereas cavernosal artery peak systolic velocity identified 130 men and cavernosal artery occlusion pressures identified 136 men. Ninety-six men had cavernosal venous leakage demonstrated during dynamic infusion cavernosometry and cavernosography. The correlation between maintenance flow rate (Qm) and cavernosal pressure decay rate during pressure loss cavernosometry (dccp) was good (R = 0.95). The Resistance Index (RI) calculated during cavernosal duplex ultrasonography determined 15 min after vasodilator challenge corrected identified 93 out of 96 venous leakers and 68 of the 72 non-venous leakers. However, the Resistance Index (RI) determined 5 min after vasodilator challenge whilst correctly identifying all 96 venous leakers, identified only 5 of the 72 non-venous leakers and incorrectly categorising the remaining 67 non-leakers as having venous leakage. In conclusion, both the peak systolic velocity and cavernosal artery occlusion pressure are accurate predictors of cavernosal artery insufficiency, whereas the penobrachial index is a poor predictor. Cavernosal duplex ultrasonography appears as reliable as angiography, is less invasive and more cost effective. The RI is an accurate predictor of cavernosal venous leakage only if determined once maximal response to vasodilator challenge has occurred.

5483158 Method and apparatus for tuning MRI RF coils

Standard operating procedures (SOP) for penile duplex Doppler ultrasound (PDDU) were published in 2013 to promote uniform vascular assessment for erectile dysfunction (ED). However, SOPs do not specify a standard anatomic location for cavernosal artery (CA) imaging.The aim of this study was to determine the effects of CA imaging location on measured penile hemodynamics assessed by PDDU.PDDU was performed in men with ED and/or Peyronie's disease. CA peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured at three points: the origin of the CA within the penile crus, the proximal CA, and mid‐CA. Differences in PSV and EDV were assessed by Friedman test and categorical vascular outcomes by Fisher's exact test. Data were analyzed for the main cohort, the subgroup with maximal smooth muscle relaxation (SMR) as defined by negative EDV, and the subgroup with valid‐for‐intromission erections.Mean PSV and EDV at three specified CA locations and the vascular diagnoses resulting from these measurements.One hundred four CAs were imaged in 52 men. Mean PSVs at the crus, proximal, and mid‐CA were 52.9 ± 20.2, 29.5 ± 15.1, and 21.6 ± 10.6 cm/s, respectively (P < 0.0001); mean EDVs were 2.1 ± 8.9, 3.2 ± 5.4, and 3.3 ± 3.5 cm/s, respectively (P = 0.1225). The distribution of arteriogenic (P < 0.0001) and venogenic (P < 0.0001) diagnoses both differed significantly by location. Significant differences in vasculogenic diagnoses were also observed in the subgroup of CAs with definite maximal SMR (n = 38, arteriogenic P < 0.0001, venogenic P = 0.007) and in those with valid‐for‐intromission erections (n = 68, arteriogenic P < 0.0001, venogenic P = 0.0002).There is large variability in measured PSV and EDV on PDDU depending on the site of Doppler imaging, which can often sway clinical diagnosis. Future guidelines should attempt to incorporate standard locations of CA imaging, and new normative values may be necessary for each location. Pagano MJ and Stahl PJ. Variation in penile hemodynamics by anatomic location of cavarnosal artery imaging in penile duplex Doppler ultrasound. J Sex Med 2015;12:1911–1919.