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Erection was graded at 10 minutes as follows: 1- no erection; 2- slight tumescence; 3- full volume without rigidity; 4- incomplete rigidity but sufficient for sexual intercourse; 5- full erection with unbending rigidity. Two patients had primary erectile dysfunction and sixty eight had developed this problem after a period of normal sexual activity. Both patients with primary erectile dysfunction had arterial insufficiency on Doppler study. The duration of symptoms varied from 2 months to 3 years in cases of acquired erectile dysfunction. Four patients had diabetes mellitus and all of them had arterial insufficiency.
Detumescence was noted in all these cases in about minutes. No priapism case was encountered in this study. No patient in the vasculogenic group achieved a satisfactory erection. The other patient did not develop curvature during the study.
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These two patients had some delayed response to the injection but did not reveal arterial insufficiency or venous leak. The normal male sexual response cycle can be functionally divided into five interrelated events that occur in a defined sequence: libido, erection, ejaculation, orgasm, and detumescence. The functional classification of the male sexual cycle is the most physically quantifiable one. In during a vascular reconstructive procedure, Ronald Virag noted that infusion of papaverine into the hypogastric artery produced erection. In a dramatic demonstration of the efficacy of penile self injection was offered by Charles Brindley, who injected himself.
The demonstration that vasoactive injections could produce penile erection without benefit of psychic or tactile stimuli revolutionized the diagnosis and treatment of erectile dysfunction by providing a direct test of end organ integrity and offering an etiology specific therapy.
In contrast to pudendal arteriography, duplex sonography is not invasive and can be performed in the office setting. The high resolution ultrasound probe allows the sonographer to image the individual cavernous arteries selectively and perform Doppler blood flow analysis simultaneously. A fall of resistance within the corporeal vascular bed and the subsequent increase in arterial inflow are the major vascular events leading to erection of the penis.
Vasculogenic ED patients have more markedly impaired endothelial and smooth muscle functions compared with patients having similar risk factors but no ED.
Color Doppler US of the Penis
It also has an a-2 adrenergic blocking effect and acid and is a potent smooth muscle relaxant and vasodilator in man. It also has an a-2 adrenergic blocking effect and hence has the potential of reducing sympathetic overtone in patients with psychogenic erectile dysfunction. The NIH Consensus Development Conference on Impotence, held in , recommended that surgical revascularization of the penis be considered experimental and be performed only by expert surgeons and as part of clinical investigation.
Lawyers may abuse the assertion of ED in lawsuits for divorce and rape. Doppler evaluation is of considerable help in such cases. The investigation, interpretation, and characteristics of medicolegal cases may differ in countries with different cultures. The availability of effective and well-tolerated oral medications has dramatically changed the clinical approach to erectile dysfunction. Pharmacotherapy is the preferred cost-effective first-line therapy in the vast majority of patients.
The results of PDU with oral sildenafil citrate were not statistically different from prostaglandin E1. Patients commented that although PGE 1 was the strongest erectogenic agent, sildenafil citrate was the most convenient. Peyronie's disease can be self-limiting in many cases and may not require therapeutic intervention. Oral therapeutic agents include vitamin E, p-aminobenzoate. Other forms of medical therapy may include local or systemic glucocorticoids and the intralesional injection of a collagenase or a calcium channel blocker e.
Medical therapy may help patients with moderate disease, whereas surgical correction is the treatment of choice for those with severe penile deformity. Color Doppler evaluation of erectile dysfunction is an effective method for differentiating psychogenic and vasculogenic causes of erectile dysfunction. As the choices for therapy increase and become more etiology specific clinicians may look to testing like color Doppler ultrasound to develop vascular profiles to help predict treatment success with one or a combination of several agents.
A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic and diastolic flow 10 min after vasoactive drug injection. C: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection A , B , and C , respectively.
Ultrasound is a quite useful method, both for its availability and efficacy in penile evaluation: in terms of diagnosis, as in the case of penile fracture and Peyronie's disease; and in the identification of etiological factors, as in cases of priapism and erectile dysfunction. The knowledge of how to differentiate between normal and pathological aspects of the penis, as well as of how to manage Doppler techniques for this purpose, is extremely important for diagnosis and patient management. Painful penile induration: imaging findings and management.
Imaging of penile and scrotal emergencies. Sonographic evaluation of penile trauma. J Ultrasound Med. Color Doppler imaging of posttraumatic priapism before and after selective embolization. New sonographic aspects of Peyronie disease. US imaging in Peyronie's disease.
J Clin Imaging Sci. Penile duplex sonography in the diagnosis of venogenic impotence. J Vasc Surg. Ultrasound evaluation of the penis for assessment of impotence. J Clin Ultrasound. A classification based in peak systolic velocity and diastolic velocity predict sindenafil citrate success. Scan J Urol Nephrol. Sildenafil citrate for penile hemodynamic determination: an alternative to intracavernosal agents in Doppler ultrasound evaluation of erectile dysfunction. Colour Doppler ultrasound of the penis.
Clin Radiol. Mailing address: Dr.
Luis Ronan Marquez Ferreira de Souza. Uberaba, MG, Brazil, E-mail: luisronan gmail. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Services on Demand Journal. Pictorial Essay Ultrasound evaluation of the penis. Abstract Ultrasound is an excellent method for the study of penis.
In conclusion, real-time strain elastography can easily be performed to detect the stiffness of the corpus cavernosum penis accompanied by Doppler US in patients with ED. Our results revealed that ultrasound elastography could provide additional useful information on the stiffness of the cavernous body along with Doppler diagnosis.here
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Therefore, elastography may be performed concomitantly with penile US to obtain data on stiffness of corpus cavernosum penis in routine clinical practice. Conflict of interest The authors declare that they have no conflicts of interest. References 1. NIH Consensus Conference. JAMA ; Relationship of blood pressure and erectile dysfunction in men without previously diagnosed hypertension. J Sex Med ; Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol ; Williams SK, Melman A.
Novel therapeutic targets for erectile dysfunction. Maturitas ; Andersson KE, Wagner G. Physiology of penile erection. Physiol Rev ; Andersson KE. Pharmacology of penile erection. Pharmacol Rev ; Giuliano F, Rampin O. Neural control of erection.
Physiol Behav ; Penile Doppler ultrasound findings in diabetic patients with erectile dysfunction. Ege J Med ; Erectile dysfunction: An underestimated presentation in patients with diabetes mellitus. Indian J Psychol Med ; Should erectile dysfunction be considered as a marker for acute myocardial infarction? Results from a retrospective cohort study. Int J Impot Res ; Flaccid penile acceleration as a marker of cardiovascular risk in men without classical risk factors. Is erectile dysfunction predictive of peripheral vascular disease?
Aging Male ; 6: Prevalence of erectile dysfunction in thyroid disorders: comparison with control subjects and with obese and diabetic patients.