Duplex Doppler Ultrasonography Research Articles

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.

Value of Renal Artery Resistive Index in Nonazotaemic Cirrhotic Patients with Ascites

Background: Renal dysfunction is a common complication in patients with liver cirrhosis, with hepatorenal syndrome (HRS) being the most severe form. HRS is characterized by disturbances in both circulatory and kidney functions and is diagnosed by excluding other causes of renal failure. Objective: This study aimed to measure the renal artery resistive index (RI) in non-azotaemic cirrhotic patients with ascites to predict early renal haemodynamic dysfunction. Methodology: A prospective study was conducted involving 30 cirrhotic patients with ascites and 15 healthy controls. Renal artery RI was measured using Duplex Doppler ultrasonography. Inclusion criteria for patients included normal renal function, as indicated by serum creatinine ≤ 1.2 mg/dl and creatinine clearance rate ≥ 50 ml/min. Results: The mean renal artery RI was significantly higher in cirrhotic patients with ascites (70% had RI ≥ 0.70) compared to controls (all had RI &lt; 0.70). Significant differences were observed in serum bilirubin, SGPT, SGOT, and prothrombin time between cases and controls (p &lt; 0.05). Conclusion: Renal Doppler ultrasonography is a valuable noninvasive method for detecting early renal haemodynamic dysfunction in cirrhotic patients with ascites. Elevated renal artery RI can serve as an indicator of renal dysfunction, aiding in early diagnosis and management.

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

Evaluate role of High-Resolution Ultrasonography in evaluation of breast masses and its correlation with Fine Needle Aspiration Cytology

Introduction: Breast carcinoma is the most common malignant tumor among women. It contributes to a significant proportion of all cancers in women worldwide (25%). Ultrasound is a helper tool used in union with mammography and clinical examination of breast in breast lesion screening. In patients with dense breast tissue, USG is a valuable aid in picking up and characterizing lesions. It has a highly capable in spotting lesions but is poor in specificity. To boost specificity, the ACR introduced the BIRADS to categorize breast masses. Material and Methods: This is a prospective and observational study conducted in the Department of Radiodiagnosis, Al-Ameen medical college and Hospital from October 2021 to September 2022 presenting with complaints of palpable breast lesions and referred to the department of radiology. Structured proforma was used to collect the data. All the subjects who fulfilled the inclusion criteria were subjected to ultrasonography and FNAC. A high-resolution duplex Dopplersonography study using HITACHI ALOKA F-37 ultrasound machines with 5-13MHz linear transducer will be done. Results: In the study 20% had Family History of Breast Cancer. In the study on USG, margin was Circumscribed in 44%, 16% had indistinct, 28% had Micro lobulated and 12% had Spiculated. In the study on USG Echogenicity was Hypoechoic (66%), anechoic (24%), Complex cystic and solid (8%) and Isoechoic (2%). In the study on USG Posterior Echo Intensity was Post acoustic Enhancement in 18%, Shadowing in 30% and No, posterior features in 52%. In the study the study 96% had no infiltration and 4% had infiltration. In the study on Sono BIRADS, 46% were benign, 24% were Probably benign, 14% were Suspicious of malignancy and 16% were Highlysuspicious of malignancy. Conclusions: From the study it was concluded that High-Resolution Ultrasonography (BIRADS) had Sensitivity of 81.25%, specificity of 94.12%, PPV of 86.67%, NPV of 91.43%, Diagnostic Accuracy was 90%. Thus, USG is a reliable first line investigation in cases of breast lesions due to its good sensitivity and a primary diagnosis can be arrived at and the need for other investigations such as FNAC and Biopsy can be decided upon.

Safety and potential effectiveness of platelet-rich plasma and extracorporeal shock wave therapy in the treatment of erectile dysfunction after nerve-sparing radical prostatectomy in patients: pilot study

Background. Prostate cancer is the most common type of cancer in men. Radical prostatectomy (RPE), including nerve-sparing, often leads to erectile dysfunction and a significant decrease in the quality of life. The available treatments are limited in effectiveness and/or are not suitable for patients.Aim. The aim of the study was to evaluate the safety and effectiveness of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) in the treatment of erectile dysfunction in patients after nerve-sparing RPE.Materials and methods. 14 men were included in the study after unilateral or bilateral nerve-sparing RPE more than 3 months ago. The total prostate-specific antigen in all patients was less than 0.2 ng/ml 3 months or more after surgery. Age – 57.8 ± 6.2 (49–72) years, duration of erectile dysfunction – 7.6 ± 3.9 (3–16) months. Two visits per week were out for 6 weeks: in visit 1, the ESWT (Dornier Aries) was performed on penis and injections of PRP into the penis, the muscles involved in the erection were activated at the end of the session by ESWT, in visit 2, ESWT on penis. The examinations were performed on the 0 and 60 days of the study: International Index of Erectile Function (IIEF-5), Sexual Encounter Profile (SEP), Erection Hardness Score (EHS), Global Assessment Questionnaire (GAQ), International Prostate Symptom Score (IPSS), Quality of Life (QoL), total blood testosterone, to penile duplex Doppler ultrasonography (PDDU) with prostaglandin E1 analog. Inclusion criteria were absence of metastases to distant organs and lymph nodes; stage no more than T3b; IIEF-5 less than 21 points after RPE; PSV less than 30 cm/s and/or RI less than 0.8 according to the PDDU after RPE; the presence of erections before RPE.Results. Treatment was tolerated satisfactorily for all patients. Significant improvement of erectile function was noted according to IIEF-5 (p &lt;0.05), SEP (p = 0.002), EHS (p = 0.002). According to GAQ, 11 patients (78.5 %) noted a positive effect of treatment. PSV and RI in both cavernous arteries increased significantly (p &lt;0.05) according PDDU. All patients noted a dysuria decrease based on IPSS (p = 0.007) and QoL (p = 0.58). The concentration of total testosterone in the blood without significant dynamics (p = 0.192).Conclusion. There are positive effects in relation to a significant improvement in erectile function in all patients according to validated questionnaires and PDDU. The proposed treatment is a promising method of restoring patient data. The study continues on a larger sample of patients.

Role of High-Resolution Ultrasonography With Colour and Duplex Doppler in the Evaluation of Acute Scrotal Diseases.

Introduction The term 'acute scrotum' denotes the sudden initiation of pain in the scrotal region. Acute scrotum is a frequent medical condition in children and adults. Ultrasound facilitates precise diagnosis and differentiation of numerous causes of acute scrotum. The objective of our research was to assess the utility of ultrasonography in the identification and prevalence determination of causes of acute scrotum. Materials and methods Patients with acute scrotal pain referred to the Department of Radiodiagnosis at Great Eastern Medical School & Hospital (GEMS), Srikakulam, India, were added in the research. This is a prospective observational study. High-frequency linear transducer (4-15 MHz) was used for imaging. Grey scale, colour and duplex Doppler were performed routinely. The ultimate diagnosis was established by considering the clinical results, follow-up observations, intraoperative observations and, when accessible, histopathological analysis. For the statistical analysis, IBM SPSS Statistics for Windows, version 22 (released 2013; IBM Corp., Armonk, New York, United States). was used. Descriptive analysis was conducted. The Kendall rank correlation coefficient was used to evaluate the non-parametric association between side and torsion. Results A total of 120 patients were included for statistical analysis. Inflammatory pathology was the most commoncause of acute scrotum, followed by testicular torsion and torsion of testicular appendage. Testicular torsion and side of pain did not show a significant association. Conclusion High-resolution ultrasonography with colour and duplex Doppler sonography is an excellent imaging modality exhibiting exceptional sensitivity and specificity for the accurate diagnosis of acute scrotal diseases. Inflammatory pathology was the most commoncause of acute scrotum, followed by testicular torsion and torsion of the testicular appendage.

Renal resistive index as a marker of histopathological damage in diabetic and non-diabetic chronic kidney disease

BackgroundChronic kidney disease is a worldwide public health problem with diabetes being the leading cause. Renal resistive index derived by Duplex Doppler sonography, has been in use clinically to examine intrarenal hemodynamic abnormalities. However, renal biopsy remains the gold standard for the evaluation of intrarenal damage. In this study we correlated the renal resistive index in diabetic and non-diabetic kidney disease patients with the established parameters of renal dysfunction i.e. histopathological changes.ResultsThe conducted study was a cross-sectional comparative study on 114 patients (58 diabetic and 56 non-diabetic patients) over a period of 18 months. Evaluated histopathological indices and renal resistive index had a statistically significant positive correlation (glomerulosclerosis, arterial damage and tubulo-interstitial damage scores) in both diabetic and non-diabetic patients. The highest correlation was observed with tubulo-interstitial score in our study.ConclusionsRenal resistive index could be considered a marker of histological damage in both diabetic and non-diabetic kidney disease. Inclusion of resistive index in the routine diagnostic protocol of chronic kidney disease can help in the accurate assessment of intrarenal damage. Hence, it is of utmost importance as a radiologist to determine resistive index in chronic kidney disease patients and guide the clinicians for efficient management.

Effectiveness of Duplex Doppler Sonography of Portal Vein as a Supplementary Tool in Diagnosis of Pediatric Appendicitis

Background Acute appendicitis is the most common surgical emergency in pediatric patients. Ultrasound is the preferred initial imaging modality to evaluate children with clinically- suspected appendicitis. whether by directly visualizing the inflamed appendix or by using secondary signs. However. rate of falsely negative or equivocal exams is still high, leading to a risk of complications from negative appendectomies as well as delayed diagnosis. Objective To evaluate the diagnostic accuracy of portal vein flow velocity and diameter in diagnosis of pediatric acute appendicitis Patients and Methods A cross-sectional study over the course of 6 months from June until November 2021. Portal vein diameter and peak systolic flow velocity were measured for 75 pediatric patients with clinically suspected appendicitis referred to radiodiagnosis department at Ain Shams University Hospitals for a pelvi-abdominal ultrasound examination. The largest appendix diameter secondary sonographic signs, and total leucocytic count were recorded if available. Results The mean age of the population was 112 ± 4.12 years (range. 3-18 years). Mean portal vein flow velocity was 38.94 ± 9.59 cm/s in the appendicitis group and 27.96 ± 6.98 cites in the non-appendicitis group. Median portal vein flow velocity was significantly higher in the appendicitis group (p &amp;lt; 0.001 with an overall diagnostic accuracy 82.1% at cut-off value of &amp;gt; 33.3 cm/sec. Mean portal vein diameter was 9.37±2.01 mm in the appendicitis group and 8.84 ± 2.19 mm in the non-appendicitis group, showing no statistically significant difference (P = 0.27). The presence of right iliac fossa echogenic fat was highly significant (P &amp;lt; 0.001) in predicting acute appendicitis. Conclusion The use of portal vein velocity as a supplementary tool improved the diagnostic performance and increased the sensitivity of ultrasound in diagnosing acute appendicitis. thus, decreasing the incidence of delayed appendectomies that have an increased risk of complications as well as decreasing the incidence of unnecessary appendectomies. Further studies are required to establish a comprehensive guideline to use it as a tool in ultrasound examinations of these patients.

Preoperative assessment for vascular access: Vascular mapping and handgrip strength.

Reliable vascular access (VA) is required for patients receiving chronic hemodialysis (HD) treatment. Vascular mapping using duplex doppler ultrasonography (DUS) can aid in planning VA construction. Greater handgrip strength (HGS) was found to be associated with more developed distal vessels both in chronic kidney disease (CKD) patients and healthy individuals, and patients with lower HGS had worse morphologic vessel characteristics and were, therefore, less likely to construct distal VA. This study aims to describe and analyze clinical, anthropometric, and laboratory characteristics of patients who underwent vascular mapping prior to VA creation. Prospective analysis. Adult patients with CKD referred for vascular mapping, at a tertiary center, between March 2021 and August 2021. Preoperative DUS by a single experienced nephrologist was carried out. HGS was measured using a hand dynamometer, and PAD was defined as ABI < 0.9. Sub-groups were analyzed according to distal vasculature size (<2 mm). A total of 80 patients were included, with a mean age of 65.7 ± 14.7 years; 67.5% were male, and 51.3% were on renal replacement therapy (RRT). Twelve (15%) participants had PAD. HGS was higher in the dominant arm (20.5 ± 12.0 vs 18.8 ± 11.2 kg). Fifty-eight (72.5%) patients had vessels smaller than 2 mm in diameter. There were no significant differences between groups concerning demographics or comorbidities (diabetes, HTN, PAD). HGS was significantly higher in patients with distal vasculature greater than or equal to 2 mm in diameter (dominant arm: 26.1 ± 15.5 vs 18.4 ± 9.7 kg, p = 0.010; non-dominant arm: 24.1 ± 15.3 vs 16.8 ± 8.6, p = 0.008). Higher HGS was associated with more developed distal cephalic vein and radial artery. Low HGS might be an indirect sign of suboptimal vascular characteristics, which might help predict the outcomes of VA creation and maturation.

An ultrasound-guided no incision banding method for the treatment of arteriovenous fistula high-flow in hemodialysis

Objective High-flow vascular access is one of the serious complications in the maturation and subsequent use of arteriovenous fistula (AVF). We adopted a novel surgical approach named no incision limited ligation indwelling needle assisted- revision (NILLINR) to treat high-flow of the hemodialysis vascular access and ascertained the outcomes by regular follow-up visits. Methods This is a retrospective study. 26 hemodialysis patients with symptomatic high-flow access (access flow > 1500 mL/min) were treated with the novel banding method without incision between June 2018 and October 2020. The flow of the brachial artery before and after the restriction was measured by experienced clinicians by using the duplex Doppler ultrasound (DUS). All 26 patients were followed up for up to 1 year. Meanwhile, the brachial artery flow was recorded at 6 months and 1 year after restriction. Results Of all 26 patients included in this study, the mean access flow volume decreased from 2196.2 ± 416.9 mL/min (mean ± SD) to 679.2 ± 67.1 mL/min immediately after the operation. During the follow-up, the volume flow of the brachial artery was still within the restricted range at 6 months (mean ± SD, 720.2 ± 164.7 mL/min) and 1 year (mean ± SD, 713.9 ± 173.8 mL/min) after the operation. Meanwhile, the mean duration of the operation is 8.5 ± 3.3 min, and there is no bleeding or rupture. Conclusion This novel no-incision limited ligation indwelling needle-assisted revision is a safe, effective, and time-saving option to treat high-flow access.

#3866 PREOPERATIVE ASSESSMENT FOR VASCULAR ACCESS: VASCULAR MAPPING AND HANDGRIP STRENGTH

Abstract Background and Aims A reliable vascular access (VA) is required for patients receiving chronic hemodialysis (HD) treatment. VA choice is complex and must consider patient characteristics, predicted patency and risk of primary failure. Vascular mapping (VM) by duplex doppler ultrasonography (DUS) can aid in the planning of which VA to place. Peripheral artery disease (PAD) is associated with higher AVF failure and can be assessed by calculating the ankle-brachial index (ABI). Muscle strength is independently associated with mortality risk and can be evaluated with handgrip strength (HGS). This study aims to describe and analyze clinical anthropometric and laboratory characteristics of patients referred for vascular mapping prior to VA creation and to correlate VM data, HGS, and ABI. Method Prospective analysis of all adult patients with CKD who were referred for VM, at a tertiary center, between March 2021 and August 2021. No patients were excluded. Preoperative DUS by a single experienced nephrologist was carried out. HGS was measured using a Hand Dynamometer and PAD was defined as ABI&amp;lt;0.9. According to distal vasculature size (&amp;lt;2mm) sub-groups were analyzed. Results 80 patients were included and 67.5% were male, mean age 65.7 ± 14.7 years and 51.3% were on Renal Replacement Therapy (RRT). Twelve (15%) participants had PAD. HGS was higher in dominant arm (20.5 ± 12.0 kg vs 18.8 ± 11.2 kg). Fifty-eight (72.5%) patients had vessels smaller than 2 mm in diameter. There were no significant differences between groups concerning demographic and comorbidities (diabetes, PAD). HGS was significantly higher in patients who had vessels greater than or equal to 2 mm in diameter (26.1 ± 15.5 kg vs 18.4 ± 9.7 kg, p = 0.010). Conclusion Greater HGS was associated with more developed distal vessels. Low HGS might be an indirect sign of poor vascular characteristics, which might help predict the outcomes of VA creation and maturation.

Effects of oral propranolol on the resistive and pulsatility indices of major abdominal vasculatures in domestic short-haired cats.

No study has been performed regarding the effects of oral administration of propranolol on pulse-wave spectral Doppler indices of major abdominal vessels in healthy adult cats. The objective of this study was to assess the pulse-wave spectral Doppler indices of abdominal aorta, caudal vena cava, and portal vein in clinically normal adult domestic short-haired (DSH) cats, before and after propranolol ingestion. Twenty intact adult client-owned DSH cats were evaluated (10 males and 10 females). A duplex Doppler ultrasonography machine with a 10-MHz frequency linear transducer was used. Peak systolic velocity, end-diastolic velocity (EDV), resistive index (RI), pulsatility index (PI), and pressure gradient were measured. All the cats received 1mg/kg of propranolol tablet, and after 2 h, ultrasonography measurements were repeated. The mean RI of the aorta and caudal vena cava significantly decreased in male cats following oral administration of propranolol after 2 h (p = 0.03, p = 0.02). In the caudal vena cava, the PI decreased from 2.98±0.62 to 1.15±0.19 post-propranolol ingestion (p = 0.01). The mean EDV in the caudal vena cava of males and portal veins of females significantly decreased after propranolol ingestion (p = 0.04, p = 0.02). This study showed that propranolol decreased the PI of the aorta and PI and RI of the caudal vena cava in healthy normal cats 2 h post-propranolol ingestion at the dosage of 1mg/kg.

Portal hemodynamic effects of different TKIs in patients with advanced hepatocellular carcinoma: A prospective cohort study.

e15126 Background: Tyrosine kinase inhibitors (TKIs) are considered to have effects on portal collateral circulation with portal hypertension. According to previous small sample clinical reports, short-term administration of sorafenib might have an effect of decreasing portal venous pressure, while lenvatinib aggravated portal hypertension. Long-term effects of TKIs on portal pressure are still unclear. Therefore, We conducted a prospective cohort study to explore the efficacy of different TKIs for portal circulation in patients with advanced hepatocellular carcinoma. Methods: 27 Child-Pugh class A or B patients with advanced HCC were enrolled in this study, 13 patients received lenvatinib, 7 patients sorafenib, and 7 patients regorafenib. Changes of portal hemodynamic parameters were measured by duplex Doppler ultrasonography, including portal venous area (PVA), portal venous flow velocity (PVV) and congestion index (CI) before and after administration of TKIs for an average 40-50 days. Results: In both regorafenib and sorafenib cohorts, PVA decreased after treatment, although the difference was not significant. PVF significantly reduced in sorafenib cohort (24.96±5.60 vs. 15.46±4.50, P= 0.014) and regorafenib cohort (21.43±2.09 vs. 16.01±1.28, P= 0.024), therefore CI significantly increased in sorafenib cohort (0.060±0.042 vs. 0.088±0.040, P= 0.046) and regorafenib cohort (0.068±0.032 vs. 0.090±0.030, P= 0.043). In lenvatinib, both PVA and PVF have no significant change, while CI increased significantly (0.057±0.027 vs. 0.074±0.040, P= 0.030). Conclusions: In this study, TKIs showed different effects on portal hemodynamic change in advanced HCC. Large sample and long time follow-up research will be necessary to verify their clinical and mechanism effects. [Table: see text]

Assessment of Cerebral Arterial Flow Volume Changes with Carotid Vertebral Artery Duplex Doppler Ultrasound in Young-Middle-aged Subclinical Hashimoto Thyroiditis Patients.

To demonstrate cerebral arterial flow volume changes during the hypothyroid, euthyroid, and hyperthyroid phases and comparing between laboratory findings and cerebral arterial flow changes with carotid-vertebral duplex Doppler ultrasound (CVA-DUSG) in subclinical Hashimoto thyroiditis (HT) patients. According to the TSH level, 3 groups were constructed between patient cases. Group 1 (n=29) was the subclinical hyperthyroid group. In this group, the TSH level was between 0.0005 and 0.3 IU/ml. Group 2 (n=175) was the euthyroid group. TSH level in this group was between 0.3 and 4.2 IU/ml. Group 3 (n=76) was the subclinical hypothyroid group. In this group, the TSH level was above 4.2 IU/ml. The control-group (group 4) (n=71) included healthy people. In this group, the TSH level was between 0.3 and 4.2 IU/ml. After obtaining at least three consecutive waves from the bilateral internal cerebral artery and bilateral vertebral artery, volume flows were calculated using CVA-DUSG. Volume flows were calculated as peak systolic velocity + end diastolic velocity/2 × mean arterial diameter. The mean ICA(Internal Carotid Artery) and VA(Vertebral Artery) diameter was measured per ICA and VA. Total cerebral artery flow volume was defined as right ICA + right VA flow volume and left ICA + left VA flow volume. We also demonstrated topographic cerebral artery blood flow changes. Total ICA flow volume was used to assess the anterior part of the brain, total VA flow volume was used to evaluate the posterior part of the brain, right ICA + right VA flow volume was used to assess the right part of the brain, and left ICA + left VA flow volume was used to verify the left part of the brain. There were significant differences between RVA(Right Vertebral Artery) flow volume, LICA (Left Internal Carotid Artery) flow volume, total flow volume, TSH, and T3 and T4 levels in all groups according to the Dunn's multiple comparison test.(p<0.001) Mean TSH level was 0.03 (0.005-0.06) IU/ml in group 1, 2.8 (1.8-3.97) IU/ml in group 2, 7.32 (6.14-9.93) IU/ml in group 3, and 1.76 (1.17-2.49) IU/ml in the control group. The mean T3 level was 4.18 (3.55-5.38) in group 1, 2.88 (2.63-3.16) in group 2, 2.82 (2.49-3.15) in group 3, 3.14 (2.92-3.15) in the control group. The mean T4 level was 1.92 (1.29-2.5) in group 1, 1.16(1.03-1.31) in group 2, 1.01 (0.91-1.16) in group 3, 1.12 (0.97-1.30) in the control group (group 4). Mean total flow volume was 793 (745-898) ml/min in group 1, 742 (684.25-822.5) ml/min in group 2, 747 (692-824) ml/min in group 3, and 700 (673-675) ml/min in the control group. We also demonstrated topographic cerebral arterial volume flow changes with CVA-DUSG. There was a significant difference among all groups in the right and anterior parts of the brain (p < 0.001), and there was a significant difference between groups 1 and 4 in the left part of the brain (p = 0.009). This study demonstrated that total cerebral arterial volume flow increased in the hyperthyroid phase of subclinical HT cases without any internal carotid and vertebral artery diameter changes compared with the euthyroid and hypothyroid phases of subclinical HT and healthy cases. We also verified topographic cerebral arterial blood flow changes in subclinical HT cases with a real-time, easily applicable modality (CVA-DUSG) that does not include X-ray or contrast agents. There was a significant difference between all groups in the right and anterior parts of the brain and there was a significant difference between groups 1 and 4 in the left part of the brain.

(343) Predictors of Corporo-venocclusive Dysfunction (CVOD) in Men with Bilateral Nerve-sparing Radical Prostatectomy (RP)

Abstract Introduction Nerve-sparing status (NSS) during RP is a significant predictor of erectile function recovery (EFR). Poor nerve sparing is associated with collagenization of cavernosal smooth muscle and CVOD development with typically poor response to PDE5 inhibitors (PDE5i) and intracavernosal injection therapy (ICI). Objective This study aimed to define factors predictive of CVOD in men with bilateral NS RP. Methods Study population consisted of (i) men who underwent bilateral NS (defined by the surgeon using an institutional grading system) RP (ii) with poor response to PDE5i and ICI (iii) ≥2 years post-RP (iv) who underwent penile duplex Doppler ultrasound (DUS) (v) using a vasoactive agent redosing schedule. CVOD diagnosis was made with end-diastolic velocity (EDV) values ≥5 cm/sec bilaterally. ADT and radiation therapy were exclusions. We used multivariable modeling to define factors predictive of CVOD. Factors included in the model: patient age, history of diabetes, history of obstructive sleep apnea, number of vascular comorbidities, baseline EF, peri-RP total testosterone (T) level, and total T at DUS (within 3 months). Results 201 men with a mean age of 66 ± 7 years. 25% of the patients reported 3 or more vascular comorbidities, 17% had diabetes, 36% obstructive sleep apnea, 39% were current or former smokers. Mean baseline PSA and pre-RP total T was 6.7 ± 6 ng/mL and 410 ± 211 ng/dL, respectively. Median baseline EFD score was 24 (13, 29). 49% of the men had an erection less than penetration rigidity during the DUS procedure with a mean total dose administered of 87 ± 21 units of trimix. 69% received 100 units. CVOD was diagnosed in 76%. Mean total T at DUS was 386 ± 177 ng/dL. 32% had low T. Significant predictors of CVOD after RP in men with BL NSS were: OSA (OR = 3.8, 95% CI = 1.7-8.7), ≥ 3 vascular comorbidities (OR = 5.0, 95% CI = 1.7-14.8), age at the time of DUS (per 10 years increase, OR = 1.9, 95% CI = 1.2-3.0), and pre-RP EF domain score (per 1 unit increase, OR = 0.93, 95% CI 0.88-0.98). There was a signal that in a larger sample size, diabetes may be a significant predictor of CVOD in this group of patients (OR = 2.7, 95% 0.9-8.0). Conclusions Baseline clinical comorbidities pre-RP have a significant impact on EFR post-RP, in particular, the presence of venous leak. Despite BL NSS, older patients, men with OSA, higher number of comorbidities pre-RP, and lower pre-RP EF increased the likelihood of developing CVOD post-RP. Disclosure No

(493) Utilization of Intracavernosal Injection and Penile Ultrasound in the Evaluation of Erectile Dysfunction and Peyronie’s Disease

Abstract Introduction Intracavernosal injections (ICI) and penile duplex Doppler ultrasound (DDUS) play a diagnostic role for patients with erectile dysfunction (ED) and Peyronie’s disease (PD). They can help to identify vascular and anatomical changes that may guide medical and surgical management; however, contemporary utilization rates of ICI and penile DDUS have not recently been described. Here we use a multicenter database to determine utilization of ICI and penile DDUS in patients with ED and PD. Objective To evaluate the rates of ICI and penile DDUS in patients with ED and PD using a global database. Methods TriNetX is a research network of real-time data from 58 Healthcare Organizations globally. Using the International Classification of Diseases Tenth Edition (ICD-10) codes, we queried the network for adult men with ED (N52) being medically treated with phosphodiesterase (PDE)-5 inhibitors from 2002 - 2022. This included sildenafil, tadalafil, vardenafil, and avanafil. Current Procedural Technology (CPT) codes were utilized to identify patients who received penile DDUS (93980, 93981) and penile prosthesis (54400, 54401, 54405). ICD-10 codes were utilized to query the network for those with PD (N48.6) from 2002 – 2022. We then used CPT codes to search within this cohort for those who had ICI (54235) excluding patients that also had penile DDUS (93980, 93981). We separately queried for patients that had penile DDUS (93980, 93981). Finally, we queried for patient who received either evaluation method and had injection therapy (54200), penile plication (54360), or plaque excision +/− grafting (PEG) (54110, 54111, 54112). The analysis was run on June 30, 2022. Results The cohort with ED on a PDE-5 inhibitor in the TriNetX database included 613,323 patients. The cohort had a mean age of 63 +/− 13 years and racial demographics of 18% black and 70% white. 8,540 patients (1.4%) had a penile DDUS and 868 (0.1%) went on to penile prosthesis (Figure 1A). A second study cohort included 46,743 patients with Peyronie’s disease with a mean age of 62 +/− 13 years and racial demographics of 8% black and 73% white. ICI was performed in 2,960 (6.3%) PD patients: 568 (1.2%) then underwent injection therapy, 1,128 (2.4%) penile plication, and 142 (0.3%) PEG (Figure 1B). Penile DDUS was performed in 4,972 (10.7%) patients with PD: 955 (2.0%) then underwent injection treatment, 474 (1.0%) penile plication, and 255 (0.5%) PEG (Figure 1B). Conclusions For ED, penile DDUS is used in a low percentage of evaluations. For PD, penile DDUS is used more commonly than ICI only. After evaluation with penile DDUS, the most common therapy is injection. After an evaluation with ICI only, the most common therapy is penile plication. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific and Coloplast.

(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

(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

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 ...

Renal Resistive Index: Revisited.

Introduction Chronic kidney disease (CKD) is universally considered a public health burden and the majority of cases are found to be diabetic at the time of diagnosis. Renal biopsy is the prime modality for the complete evaluation of renal injuriesbut is invasive. Duplex Doppler sonography can help to determine renal resistive index (RRI), which is an excellent marker for demonstrating dynamic or structural changes of intrarenal vessels. In this study, we evaluated the intrarenal hemodynamic abnormalities with RRI in diabetic and non-diabetic kidney disease patients. Also, RRI was correlated with the established parameters of renal dysfunction, i.e., estimated glomerular filtration rate (eGFR) and other biochemical parameters. Results There was a significant correlation of RRI with eGFR and serum creatinine indicating its role as a Doppler parameter, which can be used as complementary to biochemical parameters. A remarkable difference was noted in the RRI values between diabetic and non-diabetic groups in the early stages of CKD, revealing its ability to arrive at etiopathogenesis in the early stages. The renal resistive index increases in a sequential pattern and is an indicator of declining renal function. Conclusions The addition of sonographic parameters like renal resistive index could help in the complete evaluation of chronic kidney disease in diabetic and non-diabetic groups. A sequential increase in renal resistive index is a better indicator of the progressive worsening of renal function as opposed to an absolute cut-off value.