Color Duplex Doppler Research Articles

Randomized trial of low intensity shockwave therapy for erectile dysfunction utilizing grayscale ultrasound for analysis of erectile tissue homogeneity/inhomogeneity.

Electrohydraulic shockwave devices have been Food and Drug Administration-cleared for improved blood flow and connective tissue activation and have been used to treat erectile dysfunction (ED). In this study, the main focus was to evaluate improvement in erectile tissue quality after low intensity shockwave therapy (LiSWT). A single-blind, sham-controlled, randomized, prospective study, was performed in men with ED naïve to shockwave or radial ballistic pressure wave therapy. Participants were randomized 1:2 to simulated (sham) or active LiSWT treatment. After simulated treatments, participants in the Sham Arm were converted to active LiSWT, while participants initially in the Active Treatment Arm received no further treatment. Assessments were performed at baseline and two follow-up visits. Subjective parameters of erectile function (EF) were assessed by total and EF domain scores of the International Index of Erectile Function (IIEF) and sexual encounter profile (SEP). Objective parameters of penile erection were measurements of hypoechoic areas in images obtained by grayscale ultrasound (GUS) with high resolution 15.4 MHz probe and cavernosal artery peak systolic velocity (PSV) and end diastolic velocity (EDV) by color duplex Doppler ultrasound (DUS). Outcome measures for erectile and urinary function were also obtained. Simulated LiSWT did not significantly change any assessment parameter. Sham Arm participants who converted to active LiSWT had significantly increased mean IIEF total (P=0.02) and IIEF-EF scores that approached statistical significance (P=0.06), relative to baseline. Similarly, at the end of the study, Active Treatment Arm participants had significantly increased mean IIEF total (P=0.02) and IIEF-EF scores that approached statistical significance (P=0.07), relative to baseline. Additionally, at the end of the study, SEP3 success rates (erection lasting long enough for successful intercourse) approached statistical significance when Sham Arm participants were converted to active LiSWT (P=0.08) and reached statistical significance in the Active Treatment Arm (P=0.049). GUS assessments by visual grading were significantly correlated to IIEF-EF score (P=0.002) and were significantly increased relative to baseline in the Active Treatment Arm at follow-up Assessment 1 (P=0.03) and Assessment 2 (P=0.04). The greatest reduction in hypoechoic area after LiSWT occurred in the proximal penile shaft. EDV was also significantly reduced in the Active Treatment Arm at follow-up Assessment 1 (P=0.04) and Assessment 2 (P=0.04). LiSWT also resulted in improved prostate symptom scores, approaching significance in the Active Treatment Arm (P=0.055) with no changes in prostate-specific antigen. Treatment-related adverse events were limited and transient. In this prospective trial, LiSWT was safe and efficacious for erectile symptoms using GUS imaging as a novel, non-invasive method to assess improvements in corporal veno-occlusive function. Improved veno-occlusion and reduced hypoechoic area demonstrated by GUS imaging suggest that LiSWT decreases connective tissue content in penile erectile tissue. Lower urinary tract symptoms also improved with LiSWT. NCT06600893 on clinicaltrials.gov.

Penile curvature severity in patients with Peyronie's disease does not correlate with dynamic color doppler duplex ultrasound parameters: findings from a real-life cross-sectional study.

There is inconsistent data regarding the possible inaccuracies in dynamic penile color Doppler duplex ultrasound (CDDU) measurements in men with penile curvature because of Peyronie's disease (PD). We sought to explore the relationship between the degree of penile curvature and CDDU parameters in men with PD. Comprehensive data from 154 consecutive men presenting with PD as their primary complaint at a single academic center were prospectively collected and analyzed. All men underwent CDDU. Penile curvature was measured using a goniometer at time of maximum erection during CDDU. Patients were grouped based on CDDU parameters into-normal (average peak systolic velocity [PSV] ≥ 35cm/s and resistance index [RI] ≥ 0.85) and pathological CDDU (average PSV<35cm/s and/or RI<0.85). Descriptive statistics was used to compare the two subcohorts. Linear regression models were fitted to explore the association between the degree of penile curvature and dynamic CDDU parameters. Overall, the median interquartile range (IQR) age was 56 (48-63) years. The median (IQR) PSV and degree of penile curvature were 48.8cm/s (37.9-58.5) and 40 degrees (30-60), respectively. At CDDU, the degrees of penile curvature were as follows: 10-30 degrees in 63 (40.9%) men, 30-70 degrees in 70 (45.5%) men, and 70-90 degrees in 21 (13.6%) men, respectively. Of all, 116 (75.3%) patients showed a PSV>35cm/s and RI ≥ 0.85. Patients with pathologic vs. normal CDDU parameters did not differ in median (IQR) curvature (32.5° [30°-58.7°] vs. 40° [30°-65°], p=0.5) or in the distribution across curvature range groups. Linear regression analysis revealed that the degree of penile curvature did not significantly correlate with PSV at CDDU (coefficient: 0.06, p=0.3). Our study confirms the lack of a significant correlation between the severity of penile curvature and CDDU parameters in men presenting with PD. These findings emerge to be relevant in terms of a more accurate management work-up for PD patients and hold insightful medicolegal implications and in the real-life setting.

The value of shear wave elastography combined with red blood cell distribution width in evaluating arterial erectile dysfunction

PurposeA retrospective study was conducted to determine the value of shear wave elastography (SWE) and red blood cell distribution width (RDW) in the diagnosis of various forms of erectile dysfunction (ED).MethodsWith the method of Nocturnal Penile Tumescence and Rigidity (NPTR) and the screening method of Color Duplex Doppler Ultrasound (CDDU), hematological data were collected from 131 individuals, among whom 24 are with psychogenic ED, 48 are with non-arterial ED(NAED) and 59 are with arterial ED(AED) with erectile dysfunction. SWE value of penile corpus cavernosum(CCP) and cavernous arterial flow velocity were measured before (flaccid state) and after (erect state) intracavernous injection (ICI) in all patients.ResultsAmong the AED patients and other types of ED patients, there were statistically significant differences in the abridged five-item International Index of Erectile Function (IIEF-5), red blood cell distribution width-coefficient of variation (RDW-CV), red blood cell distribution width-standard deviation (RDW-SD), and SWE values (all P < 0.01). In the AED patients, the IIEF-5 scores had a significant negative relationship with RDW-CV, RDW-SD, and SWE values, with SWE values having the strongest correlation. (p < 0.001, r=-0.638).ConclusionThe combination of RDW level and SWE value demonstrated the greatest performance in diagnosing AED, according to the receiver-operator characteristic(ROC) curve analysis (AUC = 0.870, p < 0.0001, cut-off value of 0.75, sensitivity of 74.6%, specificity of 91.7%).RDW and SWE value may develop into an incredibly simple, practical tool for predicting and diagnosing AED.Trial registrationretrospectively registered.

Stem cell therapy in diabetic men with erectile dysfunction: a 24-month follow-up of safety and efficacy of two intracavernous autologous bone marrow derived mesenchymal stem cells injections, an open label phase 2 clinical trial

BackgroundRecently we reported results of phase 1 pilot clinical trial of 2 consecutive intracavernous (IC) injection of autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) for the first time in the treatment of diabetic patients with erectile dysfunction (DM-ED). In phase 2 of this study our aim is to evaluate long term safety and efficacy of IC injections of BM-MSC on additional eight patients with DM-ED.ResultsEach patient received 2 consecutive IC injections of BM-MSC and evaluated at 1, 3, 6, 12, and 24-month time points. Primary outcome was the tolerability and safety of stem cells therapy (SCT), while the secondary outcome was improvement of erectile function (EF) as assessed using the International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS) questionnaires, and Color Duplex Doppler Ultrasound (CDDU). IC injections of BM-MSCs was safe and well-tolerated. Minor local and short-term adverse events related to the bone marrow aspiration and IC injections were observed and treated conservatively. There were significant improvement in mean IIEF-5, EHS, all over the follow-up time points in comparison to the baseline. At 24-month follow up there were significant decline in the mean IIEF-5, and EHS compared to the baseline. The mean basal and 20-min peak systolic velocity was significantly higher at 3-month after the IC injections compared to baseline.ConclusionsThis phase 2 clinical trial confirmed that IC injections of BM-MSC are safe and improve EF. The decline in EF over time suggests a need for assessing repeated injections.Clinical trial registrationNCT02945462

Evaluation of renal resistive index and new biomarkers in post-hepatitis C cirrhosis patients for developing kidney injury

Background In liver cirrhosis, hemodynamic changes in splanchnic and systemic circulations are involved. Indeed, no established laboratory markers for altered renal hemodynamics in cirrhosis were implicated. The duplex Doppler waveform analysis of intrarenal arteriolar vessels is considered a noninvasive estimate of renovascular impedance and renal arterial vasoconstriction. In particular, the renal resistive index (RRI) is considered as the best reliable indicator of renal blood flow in patients with different diseases. The study aimed to evaluate RRI, serum and urinary cystatin C, beta-trace protein, liver fatty acid protein, and kidney injury molecule-I as noninvasive indicators of altered renal hemodynamics in patients with cirrhosis with normal urea and creatinine. Patients and methods A case–control study included 60 patients with post-hepatitis C virus (HCV) cirrhosis and 40 healthy controls. Serum and urinary biomarkers were measured. Renal color Doppler duplex was used to evaluate RRI. Results Mean serum and urinary biomarkers in HCV patients were significantly higher than controls. Moreover, the RRI was higher in patients than in controls with P value less than 0.001. Rising levels of urea, high direct bilirubin, and hypoprothrombinemia with high serum kidney injury molecule 1 and RRI were significant independent predictors for subsequent kidney injury. Conclusion Urinary kidney injury molecule 1 is a reliable, sensitive, and specific biomarker for the prediction of kidney injury among HCV cirrhotic patients with an obvious superior test performance and specificity to e other biomarkers. An increase in serum kidney injury molecule 1 and RRI were associated with poor prognosis.

Evaluation of scrotal pathology: an observational study

Background: Scrotal issues often prompt patients to seek evaluation through physical examinations and scrotal ultrasonography. Accurate diagnosis requires a comprehensive exploration of potential conditions, with both grayscale ultrasonography (USG) and duplex Color Doppler ultrasonography employed for assessment. Methods: This prospective observational study, conducted at Dhaka Medical College Hospital in Bangladesh from July 2004 to June 2005, aimed to compare the effectiveness of grayscale ultrasonography and duplex color Doppler ultrasonography in evaluating scrotal pathology. Fifty-two patients with intra-scrotal disease were included using purposive sampling. Grayscale USG and duplex color Doppler ultrasonography were performed, and demographic and clinical data were processed using MS Excel and SPSS version 23.0. Results: Grayscale ultrasonography identified hydrocele, varicocele, and epididymitis in 21%, 15%, and 13.5% of cases, respectively. Color Doppler imaging revealed various pathologies, with varicocele and hydrocele most common (21.20%). Diagnostic accuracy varied between the two techniques, with Color Doppler excelling in specific conditions such as testicular torsion (100% accuracy, sensitivity, and specificity). Overall, Color Doppler demonstrated superior accuracy (96.10%) compared to grayscale (80%). Conclusions: While both grayscale ultrasonography and duplex Color Doppler ultrasonography are valuable tools for evaluating scrotal pathology, the latter demonstrates superiority in terms of accuracy, sensitivity, and specificity. Color Doppler's effectiveness in diagnosing specific conditions suggests its preference for comprehensive scrotal assessments.

Novel Method for Identifying and Treating Erectile Dysfunction

Sexual or erectile dysfunction (ED) is the ineptitude to get or keep a hard penile erection. ED can have a detrimentaleffect on physical and psychological health. This review helps in understanding the detailed etiology of ED and variousapproaches for the management of ED. The occurrence and incidence of erectile dysfunction are on the rise among men.Various other factors greatly impact the progression of ED, including individual general health and physiological conditions suchas psychiatric or psychological problems, diabetes mellitus, genitourinary disease, cardiovascular disease, and chronic diseases.Erectile dysfunction occurs when the release of nitric oxide (NO) triggers the activation of the guanylate cyclase enzyme in thespongiosum and corpora cavernosa, leading to relaxation of the vascular smooth muscle and an increase in cyclic guanosinemonophosphate (cGMP) levels. This physiological process is essential for achieving and maintaining a firm penile erection. Somecommon and advanced methods, such as the physical method, sexual history, laboratory testing, apomorphine test, NPTR test,and color duplex Doppler ultrasound test, are used to diagnose erectile dysfunction. This review also focuses on emergingtreatments that address the medical need for effective ED management. This comprehensive review bridges gaps in the currentliterature, offering superior insights into ED management and improving the quality of life for individuals with ED.

Assessment of Risk Factors of Deep-Vein Thrombosis after Lower Limb Surgery

Background: Deep vein thrombosis is one of the most common condition affecting adults worldwide. The condition is characterized by the presence of blood clots in the veins. The clots commonly develop in the lower limb veins. Deep vein thrombosis is the most common complication after any lower limb surgery and is a prominent complication post-orthopaedic surgery in individuals of any age due to failure of the valves. Aim and Objectives: The aim of our study is to assess the risk factors following lower limb surgery. Methodology: The individuals who fulfill the inclusion criteria were tested using ultrasonography and duplex color Doppler unit examination at 7.5 MHz and 10 MHz using high frequency probes to assess the presence of thrombus in the deep veins of the individuals who have undergone the surgeries. The assessment was recorded on the assessment sheet and analyzed using SPSS statistical software, and the results were drawn. Results: In this study, the individuals were mostly from the age group 59–68 years and a total of 202 patients were included. 136 patients are diagnosed as suffering from DVT following orthopedic surgery. Conclusion: We conclude that the occurrence of DVT after lower limb surgery depends on various factors such as the duration of surgery, the period of immobilization, prior history of DVT and post-operative stay, and various other factors such as age and gender. We found that extramedullary implants have a relative risk of 2.93. Additionally, we also concluded that clinical signs and symptoms are not reliable measures to identify incidence of DVT.

(165) Role of Penile Veno-occlusive Dysfunction in Peyronie’s Disease Patients with Erectile Dysfunction

Abstract Introduction The incidence of Peyronie's disease (PD) is 4% in the U.S. male population. Many PD patients also suffer from erectile dysfunction (ED). The etiology of ED incidence in PD men is not known, although veno-occlusive dysfunction (VOD) is often suggested. It is important to appreciate the influence of VOD in PD patients with ED, especially in regard to successful PD treatment. Objective The main objective of this study is to assess the penile hemodynamic response to intracavernous injection (ICI) of a vasoactive agent in order to evaluate the incidence of VOD in PD patients with or without ED. Methods A total of 333 men, diagnosed either with PD (n=202) or ED (n=68) or both PD and ED (n=63), visiting our Andrology clinic were included in this study. Initial ED was determined by using the International Index of Erectile Function (IIEF) score, whereas patients with penile curvature ≥30° were categorized as having PD. Penile color duplex Doppler ultrasound (CDDU) data was retrospectively collected from these patients, and parameters such as peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were used for analysis. RI (=PSV-EDV/PSV) was calculated, and VOD was confirmed when PSV ≥30 cm/sec, EDV ≥6 cm/sec, and RI &amp;lt;0.8 based on previously published guidelines for standardization of penile CDDU parameters. Statistical analysis was performed using MedCalc statistical software version 20.019 (MedCalc Software bv, Ostend, Belgium). Results Table 1 summarizes the CDDU results of all 333 patients. Age of the study subjects was 55.6 ± 11.3 years, with no difference between groups. Incidence of penile VOD was higher in patients with ED without PD (58.8%) or with PD (52.4%) compared to PD alone (44.6%). RI values of PD patients without ED were higher (&amp;gt;0.8) compared to PD patients with ED having VOD (&amp;lt;0.7) (P&amp;lt;0.001). Conclusions The current study results indicate that lower RI values suggest a higher incidence of VOD in PD patients. VOD plays an important role in the onset of ED in men with PD. Furthermore, this demonstrates the importance of performing CDDU and diagnosing the presence of VOD in further understanding the pathophysiology of PD. Disclosure No

(257) Ultrasound Classification System for Peyronie's Disease

Abstract Introduction Peyronie’s Disease (PD) is characterized by a fibrous scar of the tunica albuginea. PD is typically imaged with 2D ultrasound. We propose a classification system of these ultrasound findings in the evaluation of PD. Objective The purpose of this study is to establish a functional sonographic classification system for evaluating PD and to examine the relationship between PD grading and curvature, duration of PD, and vascular erectile status. Methods In our study, 395 patients with PD underwent intracavernosal injection with an erectile agent (ICI) followed by Color Doppler Duplex Ultrasound (CDDU). All CDDU studies were performed by a single examiner and all PD grading was done by two independent reviewers using saved images. Ultrasound findings including peak systolic velocities (PSV) and resistive indices (RIs) were recorded. PD grades of 2D images were classified into three grades: Grade 1 acoustic shadowing without calcification; Grade 2 focal microcalcifications of the tunica, pillars, or septal fibers; Grade 3 confluent calcification of the dorsal, septal, ventral tunica albuginea. Results There were 250 patients classified with Grade 1 (63%) sonographic changes, 75 with Grade 2 (19%), and 70 with Grade 3 (18%). All groups had similar median ages and body mass index (BMI): Grade 1 (59.3 yr), Grade 2 (59 yr) and Grade 3 (60.3 yr), p = 0.711; BMI 27.6, 28.2, 27.7, p = 0.813. Additionally, medical and surgical risk factors for erectile dysfunction were similar across the three groups; these included hypertension, heart disease, diabetes mellitus, hyperlipidemia, smoking history, and history of prostate surgery. Most patients had previously used PDE5-Inhibitors (293/395). History and/or physical findings of Dupuytren’s palmar contracture was noted in 30/395 (7.6%) of men. The median duration of PD was not significantly different across the three groups (12, 12, 14 months p = 0.639). Neither CDDU diagnoses (Table 1) nor curvature varied by sonographic grades (Table 2). Conclusions The scar resulting from PD seals together the outer longitudinal and inner circular layers of the tunica albuginea causing deformity of the erect shaft. PD plaques are usually palpable and associated with focal thickening of the tunica. On 2D ultrasound, the typical appearance is an acoustic shadow. Most of our patients presented with Grade I acoustic shadowing and no calcifications 250/395 (63%). On the other hand, 19% had acoustic plaque shadowing and additional findings of focal tunica or deep microcalcifications and 18% had confluent calcification of the dorsal, septal or ventral tunica. We propose a unique and reproducible classification system for Peyronie's Disease. This grading system is based on grayscale ultrasound of Peyronie’s plaques may serve the purpose of diagnostic evaluation, didactic teaching and integrated research. Disclosure No

(118) The Atherosclerotic Cardiovascular Disease Risk Score is a Reliable Tool to Identify Patients with Arteriogenic Erectile Dysfunction at Dynamic Penile Color Doppler Duplex Ultrasound – Findings From a Real-life Cross-sectional Study

Abstract Introduction The ASCVD (Atherosclerotic Cardiovascular Disease) risk score is a validated and standardised algorithm predicting the individual 10-year risk of developing acute cardiovascular events (CVs). Patients with erectile dysfunction (ED) are at greater risk of CVs; Objective we aimed to i) apply the ASCVD score at a homogenous cohort of men undergoing dynamic penile color doppler duplex ultrasound (CDDU) for ED, and ii) explore its predictive ability to identify patients with arteriogenic and venogenic ED at CDDU. Methods Complete data of 188 consecutive patients undergoing CDDU for ED were analysed. Health-significant comorbidities were scored using the Charlson comorbidity index. All patients completed the International Index of Erectile Function (IIEF) at baseline. Serum hormones (total testosterone (tT) and luteinising hormone (LH)) were dosed for every patient. The ASCVD score was applied to the entire cohort. According to the ASCVD, patients were segregated into low (≤7.5%) vs. intermediate/high risk (&amp;gt; 7.5%). Descriptive statistics was used to explore differences between the two groups. Logistic regression models tested the potential predictive role of ASCVD scores to predict pathological CDDU parameters (peak systolic velocity (PSV) &amp;lt; 35 cm/s and/or resistance index (RI) ≤ 0.70). Local polynomial smoothing models graphically displayed the probability of pathological CDDU parameters at different ASCVD scores. Results Overall, median (IQR) age was 54 (43-60) yr. Of all, 52 (27.7%) patients reported severe ED, as for IIEF-EF ≤ 11. Overall, 80 (42.6%) showed a pure arteriogenic ED and 15 (8%) pure venogenic ED at CDDU. Intermediate/high-risk patients (52.7%) were found to have lower IIEF-EF scores, higher BMI, higher CCI and presented with a greater rate of PDE5i non-responders compared to those with low-risk (47.3%) according to ASCVD (all p&amp;lt;0.005). Conversely, the two groups did not significantly differ in terms of CDDU parameters. At logistic regression analysis, the ASCVD risk score was identified as a strong predictor for arteriogenic ED at CDDU (OR: 1.07, 95% CI: 1.03-1.13, p = 0.007) after adjusting for BMI. Conversely, the ASCVD score was not identified as a predictor of pure venogenic ED (OR: 1.04, 95% CI: 0.98-1.1, p = 0.22). Figure 1 displays the probability of pathological findings at CDDU (PSV &amp;lt; 35 cm/sec vs. RI &amp;lt; 0.7) at different ASCVD scores. Conclusions The ASCVD risk score can be used as a valuable tool to identify patients with arteriogenic ED at CDDU in real-life settings. Since vasculogenic ED may anticipate CVs even by some years, the accurate identification of patients with deficient cavernosal arterial flow would certainly allow earlier and more effective cardiovascular prevention in this subset of patients. Disclosure No

(529) Etiology of Erectile Dysfunction in Patients who Underwent Endourological Procedures for Prostate vs. Robotic and Open Radical Prostatectomy.

Abstract Introduction Erectile dysfunction continues to be a concern for patients and physicians after surgical treatment of prostate pathology. Objective To analyze doppler diagnosis on patients who underwent prostate surgery for benign or malignant pathology of the prostate. Methods We retrospectively analyzed all patients who underwent either robotic assisted prostatectomy (RALP), open retropubic prostatectomy (RRP), endoscopic procedures such as greenlight procedure, laser resection of the prostate or transurethral resection of the prostate (TURP); and High Intensity Focused Ultrasound (HIFU) treatment for prostate pathology and who underwent intracavernous injection followed by Color Doppler Duplex Ultrasound (CDDU) at our institution between 2005 and 2019. CDDU findings were recorded following injection of low dose alprostadil (10-20 mcg) and again after a period of privacy and visual sexual stimulation. CCDU findings including peak systolic velocities (PSV), and resistive indices (RIs) were recorded. Arterial insufficiency (AI) was defined as either a post-stimulation PSV &amp;lt; 25 with any RI or a PSV 25-34.9 with RI≥0.9. Cavernous Venous Occlusion Disease (CVOD) was defined as post-stimulation PSV ≥35 with RI &amp;lt; 0.9. Mixed was defined as post-stimulation PSV 25-34.9 with RI &amp;lt; 0.9. Vascular normal was defined as post-stim PSV ≥ 35 with RI ≥ 0.9. Results 380/1917 (19.8%) patients had a past surgical history of prostate surgery. 111/380 (29.2%) underwent RRP, 168/380 (44.2%) patients underwent RALP, 85/380 (22.3%) underwent endourological resection of the prostate and 2/380 (0.5%) patients underwent HIFU. Median age for the RALP group was 60.5 (IQR 23.7-82.8), RRP group was 64.2 (29.7-87.7), endourological resection of the prostate 64.6 (30.8 – 85.6) and HIFU 65.0 (46.9-79.4). 87.1% of patients who had an endoscopic procedure were using phosphodiesterase-5 inhibitors at the time of CDDU. CVOD was the most common etiology of ED in patients who underwent RRP (28.8%) and Endourological procedures of the prostate (32.9%); In patient who underwent RALP the most common etiology of ED was noted to be AI (28.6%), however none of these values were statistically significant (p=0.428). Conclusions There is no difference in etiology of ED in patients who underwent open, robotic or endoscopic manipulation of the prostate as shown by CDDU. Disclosure No

The atherosclerotic cardiovascular disease risk score is a reliable tool to identify patients with arteriogenic erectile dysfunction.

The atherosclerotic cardiovascular disease risk score is a validated algorithm predicting an individual's 10-year risk of developing acute cardiovascular events (cardiovascular disease). Patients who suffer from arteriogenic erectile dysfunction are susceptible to developing cardiovascular disease in the future. To apply the atherosclerotic cardiovascular disease score at a homogenous cohort of men with erectile dysfunction undergoing a dynamic penile colour Doppler duplex ultrasound and explore its predictive ability to identify patients with vasculogenic erectile dysfunction at colour Doppler duplex ultrasound. Complete data of 219 patients undergoing colour Doppler duplex ultrasound were analysed. All patients completed the International Index of Erectile Function. The atherosclerotic cardiovascular disease score and Charlson comorbidity index were applied to the entire cohort. Patients were divided into those with normal vs. pathological parameters at colour Doppler duplex ultrasound. Descriptive statistics were used to explore differences between the two groups. Logistic regression models tested the potential role of atherosclerotic cardiovascular disease to predict arteriogenic and/or venogenic erectile dysfunction. Local polynomial smoothing models graphically displayed the probability of pathological colour Doppler duplex ultrasound parameters at different atherosclerotic cardiovascular disease scores. Overall, arteriogenic erectile dysfunction and venous leakage were diagnosed in 88 (40.2%) and 28 (12.8%) patients respectively. The median (interquartile range) atherosclerotic cardiovascular disease score was 7.7 (3.9-14). Patients with pathologic colour Doppler duplex ultrasound were older (59vs. 54 years, p<0.001), had higher Body Mass Index (26.5vs. 25.6kg/m2 , p=0.04), more comorbidities (Charlson comorbidity index ≥ 1) (76.5%vs. 54.4%, p=0.002) and higher median atherosclerotic cardiovascular disease scores (9.95vs. 7, p=0.005), respectively. At logistic regression analysis, a higher atherosclerotic cardiovascular disease risk score was independently associated with arteriogenic erectile dysfunction at colour Doppler duplex ultrasound (odds ratio: 1.03, 95% confidence interval: 1.01-1.08, p=0.02) after adjusting for Body Mass Index, physical activity, alcohol consumption and severe erectile dysfunction. As vasculogenic erectile dysfunction may precede bysome years the onset of acute cardiovascular diseases, the rigorous identification of patients with deficient cavernosal arterial blood flow, would definitely allow the implementation ofearlier and more effective cardiovascular prevention strategies in men with erectile dysfunction. The atherosclerotic cardiovascular disease risk score represents a reliable tool to identify patients with arteriogenic erectile dysfunction in everyday clinical practice.

PD26-11 ERECTILE DYSFUNCTION IN PEYRONIE’S DISEASE: PREVALENCE AND ETIOLOGY AS DEMONSTRATED BY COLOR DUPLEX DOPPLER ULTRASOUND

You have accessJournal of UrologyCME1 Apr 2023PD26-11 ERECTILE DYSFUNCTION IN PEYRONIE’S DISEASE: PREVALENCE AND ETIOLOGY AS DEMONSTRATED BY COLOR DUPLEX DOPPLER ULTRASOUND Laura Geldmaker, Daniela Haehn, Sarah Hampton, Christopher Walker, Colleen Ball, and Gregory Broderick Laura GeldmakerLaura Geldmaker More articles by this author , Daniela HaehnDaniela Haehn More articles by this author , Sarah HamptonSarah Hampton More articles by this author , Christopher WalkerChristopher Walker More articles by this author , Colleen BallColleen Ball More articles by this author , and Gregory BroderickGregory Broderick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003304.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Peyronie’s Disease (PD) can coexist with erectile dysfunction (ED). International guidelines recommend that PD management includes an assessment of each patient’s ability to initiate and sustain erection, by intracavernosal injection (ICI) test with or without duplex Doppler ultrasound. Distress caused by PD may limit a patient’s ability to assess adequacy of penile rigidity. Our objective was to assess vascular erectile integrity non-invasively in the setting of PD. METHODS: Consecutive patients who underwent ICI followed by Color Doppler Duplex Ultrasound (CDDU) at our institution were retrospectively reviewed. CDDU findings were recorded following injection of alprostadil and again after a period of privacy and visual sexual stimulation (VSS). Erectile re-observations were made with patient standing after VSS. Erectile rigidity was assessed by one physician and all patients were asked to compare to their best quality home erection. CDDU findings including peak systolic velocities, end diastolic velocities, and resistive indices were recorded. Among patients diagnosed with PD, comparisons of patient characteristics between those with and without a diagnosis of ED were made using a Wilcoxon rank sum test (continuous characteristics) or Fisher’s exact test (categorical characteristics). RESULTS: Our assessment of 1853 men using CDDU found 1239 were diagnosed with PD by CDDU. Among those with PD, 353 (28.5%) were diagnosed with PD only (vascular normal) and 886 (71.5%) were diagnosed with PD+ED. Patients with a CDDU diagnosis of PD only were younger [median: 57 (49, 62) vs. 61 (55, 67) years, p<0.001], less likely to have hypertension [119/349 (34.1%) vs. 424/885 (47.9%), p<0.001], less likely to have used PDE-5 inhibitor [243/348 (69.8%) vs. 692/882 (78.5%), p=0.002], and less likely to have failed to a PDE-5 inhibitor [150/243 (61.7%) vs. 531/691 (76.8%), p<0.001] compared to men with PD+ED. Mean SHIM scores were not normal in either group. SHIM scores were higher among those with PD only [median (interquartile range): 14 (8–20) vs. 10 (6–18), p<0.001]. CDDU diagnoses for men with PD+ED were AI 284/886 (32.1%), CVOD 371/886 (41.9%), mixed vascular ED 231/886 (26.1%). CONCLUSIONS: In our practice more than 90% of men undergo history and physical examination with same day CDDU for the evaluation of PD. In this series, Doppler analysis found that 71.5% of PD patients have some form of vascular ED. We recommend an evidence-based assessment of vascular erectile integrity before any patient is triaged to medical or surgical intervention. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e739 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Geldmaker More articles by this author Daniela Haehn More articles by this author Sarah Hampton More articles by this author Christopher Walker More articles by this author Colleen Ball More articles by this author Gregory Broderick More articles by this author Expand All Advertisement PDF downloadLoading ...

Doppler Ultrasonographic Evaluation of Erectile Dysfunction in a Northern Nigerian Tertiary Hospital.

Colour duplex Doppler is a noninvasive tool for the evaluation of the vascular mechanism of erectile dysfunction (ED). It can be used to determine the integrity of the vascular mechanism and to differentiate between arterial and venous insufficiency. To identify the vasculogenic causes of ED and subclassify them into arteriogenic, venogenic, or mixed to assist in predicting the clinical outcome. A retrospective study was conducted at the Department of Radiology, ABUTH Zaria, from records of patients who had presented to the Doppler suite with symptoms of ED available between July 2020 and August 2022. A total of 23 patients were involved in this study. The age range was 25-66 years. The majority of the patients were seen in age groups 51-60 years and 41-50 years with 48% (11) and 22% (5), respectively. Only 3 (13%) of the patients were found to have normal penile Doppler study, 12 (52%) patients were found to have arteriogenic, and another 4 (17.4%) patients were found to have venogenic cause. In four (17.4%) patients, there was mixed/inconclusive picture. Among the nine (39%) patients with Peyronie's disease, only one showed normal Doppler study. The incidence of vasculogenic cause of ED was found to increase with age. The colour Doppler study is an important noninvasive nonionizing radiation tool for swift evaluation of penile erectile function and, thus, helps in classifying ED causes into structural, vascular, or possibly psychogenic, hence guiding the clinicians on the therapeutic options.

The atherosclerotic cardiovascular disease risk score is a reliable tool to identify patients with arteriogenic erectile dysfunction at dynamic penile color doppler duplex ultrasound – findings from a real-life cross-sectional study

The atherosclerotic cardiovascular disease risk score is a reliable tool to identify patients with arteriogenic erectile dysfunction at dynamic penile color doppler duplex ultrasound – findings from a real-life cross-sectional study

Streaming technology: from games to tele-ultrasound

BACKGROUND: Due to the gaming industrys rapid development, a large number of technical tools and technologies with unique characteristics have emerged. One of these technologies, which can be potentially used in medical diagnostics, is streaming (online streaming). By connecting an ultrasound scanner to a video capture system, it is possible to significantly expand the diagnostic devices functionality.&#x0D; AIM: To investigate the possibility of applying the gaming industrys information technology in telemedicine, like tele-ultrasound.&#x0D; MATERIALS AND METHODS: In this study, an ultrasound video image was captured using a video capture system developed for gamers. The video was obtained during brachycephalic arteries ultrasound in the following modes: greyscale B-mode, color duplex, and pulse Doppler mode. The examination was broadcast to a video streaming service in real time.&#x0D; RESULTS: An expert sonologist obtained optimal video image parameters and determined the minimum required video streaming settings for an adequate remote evaluation. The following video capture workstation settings are recommended: video, 1280720; 24 fps; H.264 encoder; bitrate, at least 350 Kbps.&#x0D; CONCLUSIONS: Using technical and software tools developed for video game streaming to provide tele-ultrasound is possible.

Standardizing sonographic descriptors of Peyronie's plaques

ABSTRACT Introduction Peyronie's Disease (PD) is characterized by a fibrous scar of the tunica albuginea. PD is typically imaged with 2D ultrasound. We propose a classification system of these ultrasound findings in the evaluation of PD. Objective The purpose of this study is to establish a functional, reproducible sonographic classification system for evaluating PD and to examine the relationship between PD grading and curvature, duration of PD, and vascular erectile status. Methods In our study, 395 patients with PD underwent intracavernous injection with an erectile agent (ICI) followed by Color Doppler Duplex Ultrasound (CDDU). All CDDU studies were performed by a single examiner and all PD grading was done by two independent reviewers using saved images. CCDU findings including peak systolic velocities (PSV) and resistive indices (RIs) were recorded. PD grades of 2D images were classified into three grades: Grade 1 acoustic shadowing without calcification; Grade 2 focal microcalcifications of the tunica, pillars, or septal fibers; Grade 3 confluent calcification of the dorsal, septal, ventral tunica albuginea. Results There were 250 patients classified with Grade 1 (63%) sonographic changes, 75 with Grade 2 (19%), and 70 with Grade 3 (18%). Neither median age nor body mass index (BMI) of the cohorts were significantly different: Grade 1 (59.3 yr), Grade 2 (59 yr) and Grade 3 (60.3 yr), p = 0.711; BMI 27.6, 28.2, 27.7, p = 0.813. Medical risk factors for erectile dysfunction, including hypertension, heart disease, diabetes mellitus, hyperlipidemia, smoking history, and history of prostate surgery were not statistically different for the three cohorts. Most patients had previously used PDE5-Inhibitors (293/395). History and or physical findings of Dupuytren's palmar contracture was noted in 30/395 (7.6%) of men. The median duration of PD was not significantly different in the three cohorts (12, 12, 14 months p = 0.639). Neither CDDU diagnoses (Table 1) nor curvature varied by sonographic grades (Table 2). Conclusions The scar resulting from PD seals together the outer longitudinal and inner circular layers of the tunica albuginea causing deformity of the erect shaft. PD plaques are usually palpable and associated with focal thickening of the tunica. On 2D ultrasound, the typical appearance is an acoustic shadow. Most of our patients presented with Grade I acoustic shadowing and no calcifications 250/395 (63%); on the other hand, 19% had acoustic plaque shadowing and additional findings of focal tunica or deep microcalcifications and 18% had confluent calcification of the dorsal, septal or ventral tunica. We propose a unique and reproducible classification system. This grading system based on grayscale ultrasound of Peyronie's plaques may serve as a paradigm for diagnosis, didactics and integrated research. Disclosure Work supported by industry: no, by N/A.

PD23-12 A DETAILED CHARACTERIZATION OF MEN WITH PEYRONIE’S DISEASE AND NO ASSOCIATED RISK FACTORS

You have accessJournal of UrologyCME1 May 2022PD23-12 A DETAILED CHARACTERIZATION OF MEN WITH PEYRONIE’S DISEASE AND NO ASSOCIATED RISK FACTORS Christian Corsini, Paolo Capogrosso, Edoardo Pozzi, Federico Belladelli, Giuseppe Fallara, Massimiliano Raffo, Daniele Cignoli, Luigi Candela, Nicolò Schifano, Alessia d'Arma, Luca Boeri, Eugenio Ventimiglia, Rayan Matloob, Federico Dehò, Francesco Montorsi, and Andrea Salonia Christian CorsiniChristian Corsini More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Massimiliano RaffoMassimiliano Raffo More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Alessia d'ArmaAlessia d'Arma More articles by this author , Luca BoeriLuca Boeri More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002565.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The actual aetiology of Peyronie’s Disease (PD) is still unknown. Although several associated risk factors have been identified (e.g., penile trauma, hypertension, diabetes mellitus, smoking, etc.) some patients develop PDdespite the absence of commonly recognised risk factors. We aimed to investigate the rate of and the clinical characteristics of men with PD and no risk factors versus patients with PD and at least 1 risk factor. METHODS: Complete demographic, clinical and laboratory data from 566 patients seeking first medical help for PDbetween 2015-2021 at a single tertiary-referral center were analysed. Every patient completed the IIEF-15 and PDQ questionnaires. Descriptive statistics was used to compare categorical and continuous variables, between the entire cohort segregated according to the presence of known risk factors, such as: diabetes, dyslipidemias, hypertension, ischemic cardiopathy, autoimmune diseases (e.g., Dupuytren’s disease or other connective tissue diseases), previous pelvic surgery (e.g., radical prostatectomy), smoking, alcohol consumption (>1L/week), erectile disfunction (ED), and low testosterone levels (< 3 ng/mL). Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). In order to better measure the degree of curvature after intra cavernous injection (ICI) and evaluate the penile haemodynamic (peak systolic velocity (PSV) < 35 cm/s and/or resistance index (RI) ≤ 0.80 at 20 minutes after ICI), dynamic penile color doppler duplex ultrasound (CDDU) was suggested to all patients. RESULTS: Of 566, 96 (17%) patients did not report any associated comorbidity or risk factor, and none had a positive clinical history for penile trauma. No differences were found between groups in terms of PDQ scores in each PDQ subscale (i.e., Pain, Bother and Symptoms) and serum hormones. Patients with no risk factors had lower age (median (IQR) 48 (34, 56) vs. 58 (48, 64) yrs; p<0.001), BMI (23.7 (22.0, 26,2) vs. 25.4 (23.7, 27.8) kg/m^2; p<0.001) and CCI (CCI≥1 in 3 (3%) vs. 47 (10%) patients; p=0.04). IIEF-EF was lower in patients with known risk factors (median (IQR) IIEF-EF score 20 (9, 27) vs. 26 (16.50, 28.50); p=0,03). At CDDU, patients with no risk factors for PD had worse degree of curvature (70 (52.5, 90.0) vs. 50 (30, 80) degrees; p=0.02), better PSV values (44.6 (41.7, 53.2) vs. 37.9 (30.9, 42.1) cm/s; p=0,01) and comparable RI values. CONCLUSIONS: Approximately one out of five men presenting for PD had no risk factors or known associated comorbidity. To our knowledge, this is the first study highlighting the clinical characteristics of this subgroup of patients. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e414 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Corsini More articles by this author Paolo Capogrosso More articles by this author Edoardo Pozzi More articles by this author Federico Belladelli More articles by this author Giuseppe Fallara More articles by this author Massimiliano Raffo More articles by this author Daniele Cignoli More articles by this author Luigi Candela More articles by this author Nicolò Schifano More articles by this author Alessia d'Arma More articles by this author Luca Boeri More articles by this author Eugenio Ventimiglia More articles by this author Rayan Matloob More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement PDF DownloadLoading ...

Measurement of Peak Systolic Velocities and End Diastolic Velocities of Common Carotid, Internal Carotid and Vertebral Arteries of Healthy Adult Subjects by Duplex Colour Doppler Sonography : A Study of 100 Cases

Background : Duplex Colour Doppler Sonography is a well-accepted non invasive means for diagnosis and evaluation of carotid and vertebral artery disease. As these arteries are the main supply of brain, determination of their percentage of stenosis accurately is very much important. The accuracy of measurement of percent stenosis using doppler technique depends significantly on measured blood flow velocities in these arteries. As a result, a normal reference value of peak systolic velocity and end diastolic velocity for these arteries are needed upon which the calculation of percentage stenosis depends. At this context, this study was done with the following objectives: To measure Peak Systolic Velocities and End Diastolic Velocities of common carotid, internal carotid and vertebral arteries of healthy adult subjects by duplex colour doppler sonography, to estimate the velocity difference in extra - cranial neck vessels of right and left side and to observe the velocity difference between males and females.&#x0D; Materials and methods : This cross-sectional study was conducted among Bangladeshi healthy adult subjects in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU) from January2009 to December 2009. 100 Bangladeshi healthy adult subjects were selected which included 50 males and 50 females. All the subjects underwent duplex colour doppler scanning of their Common Carotid Artery (CCA) Internal Carotid Artery (ICA) and Vertebral Arteries (VA) on both sides. Peak Systolic Velocities (PSV) and End-Diastolic Velocities (EDV) of the above arteries on both sides were recorded for analysis.&#x0D; Results: In case of male subjects, mean PSV of common carotid, internal carotid and vertebral arteries on the right side are 66, 57 and 30 cm/sec and on the left side are 72, 58 and 32 cm/sec consecutively. In the case of male subjects, mean EDV of common carotid, internal carotid and vertebral arteries on the right side are 19, 16 and 10 cm/sec and on the left side are 21, 21 and 15 cm/sec consecutively. In case of female subjects, mean PSV of common carotid, internal carotid and vertebral arteries on the right side are 62, 57 and 29 cm/sec and on the left side are 65, 57 and 30 cm/sec consecutively. In the case of female subjects, mean EDV of common carotid, internal carotid and vertebral arteries on the right side are 20, 19 and 14 cm/sec and on the left side are 21,17 and 14 cm/sec consecutively.&#x0D; Conclusion: From this study, we have provided reference values of peak systolic velocity and end diastolic velocity for these arteries (CCA, ICA &amp; VA) in Bangladeshi population.&#x0D; IAHS Medical Journal Vol 4(2), June 2021; 17-21