1
|
Flores JM, West M, Mulhall JP. Efficient use of penile Doppler ultrasound for investigating men with erectile dysfunction. J Sex Med 2024; 21:734-739. [PMID: 39091226 DOI: 10.1093/jsxmed/qdae070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/21/2024] [Accepted: 06/17/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Vasculogenic erectile dysfunction is the most common type of erectile dysfunction, and penile Doppler ultrasound (PDUS) is a useful tool to assess erectile hemodynamics in the clinician's effort to discuss prognosis and management strategies with the patient. AIM We herein describe the PDUS protocol used at our center, including indications, technique, and data interpretation. METHODS We describe our institutional experience with PDUS and discuss it in the context of a contemporary review of the literature for this investigation. OUTCOME Our institutional PDUS protocol. RESULTS To perform PDUS properly, adequate training, equipment, setting, technique, and interpretation are critical. The accuracy of PDUS is entirely predicated on achieving complete cavernosal smooth muscle relaxation. A redosing protocol optimizes the reliability and reproducibility of the hemodynamic data acquired during PDUS. A rigidity-based assessment is performed, and patients are scanned according to the erection rigidity achieved (full hardness) or by administration of maximum dose of the vasoactive agent. Peak systolic velocity is considered a measure of arterial inflow (normal, >30 cm/s), while end diastolic velocity evaluates the veno-occlusive mechanism (normal, <5 cm/s). After the procedure, the patient is evaluated to confirm detumescence. If the patient has a persistent penetration rigidity erection, intracavernosal phenylephrine is administered; however, if detumescence is not achieved with intracavernosal phenylephrine injections alone, corporal aspiration is potentially performed. CONCLUSION PDUS is a valuable minimally invasive tool for erectile hemodynamics assessment and an accurate assessment of such, provided that complete cavernosal smooth muscle relaxation is achieved.
Collapse
Affiliation(s)
- Jose M Flores
- Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Michael West
- Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - John P Mulhall
- Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| |
Collapse
|
2
|
Liang K, Ke Z, Huang J, Fei X, Qi L, Wang J. Analysis of vacuum negative pressure therapy and traditional Chinese medicine lavage in combination with tadalafil for vascular erectile dysfunction. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1335239. [PMID: 38375500 PMCID: PMC10875121 DOI: 10.3389/frph.2024.1335239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
This study investigates the clinical effects of the novel Traditional Chinese Medicine (TCM) topical wash used in combination with negative pressure irrigation and tadalafil for the treatment of vascular erectile dysfunction. Eighty-seven patients with vascular erectile dysfunction were divided into an observation group and a control group. The observation group was administered negative pressure irrigation (TCM) in combination with oral tadalafil for four weeks, and the control group was administered oral tadalafil for four weeks. The observation group included 21 patients with arterial erectile dysfunction and 22 with intravenous erectile dysfunction. After treatment, IIEF-5, EHS, GAD scores, PSV, EDV and RI in observation group were improved compared with those before treatment (P = 0.000, 0.000, 0.000, L0.000/R0.000, L0.000/R0.000, L0.003/R0.000). Erectile function (IIEF-5, EHS) was significantly improved compared with the control group (P = 0.008, 0.002). In the observation group, there were 21 cases of arterial erectile dysfunction and 22 cases of intravenous erectile dysfunction. After treatment, PSV of arterial ED improved significantly (P = L0.000/R0.000), but EDV did not decrease significantly (P = L0.084/R 0.098). In patients with venous ED, PSV increased (P = L0.026/R0.032) and EDV decreased significantly (P = L0.000/R0.000). These findings suggest that TCM negative pressure lavage combined with tadalafil improves the blood supply of the penile artery, relaxes smooth muscle, and improves the closing mechanism of venous vessels in patients with vascular erectile dysfunction, ultimately improving the erectile function.
Collapse
Affiliation(s)
- Ke Liang
- Department of Urology, The First People’s Hospital of Pinghu, Pinghu, Zhejiang, China
| | - Zunjin Ke
- Department of Urology, The First People’s Hospital of Pinghu, Pinghu, Zhejiang, China
| | - Jianhong Huang
- Department of Urology, The First People’s Hospital of Pinghu, Pinghu, Zhejiang, China
| | - Xiang Fei
- Department of Urology, The First People’s Hospital of Pinghu, Pinghu, Zhejiang, China
| | - Liang Qi
- Department of Urology, The First People’s Hospital of Pinghu, Pinghu, Zhejiang, China
| | - Jie Wang
- Department of Urology, Zhejiang Hospital, HangZhou, Zhejiang, China
| |
Collapse
|
3
|
Verze P, Belmonte M, Cai T, Otero JR. The penile ultrasound study: an unnecessary exam or an ace in the hole? Int J Impot Res 2022; 34:505-506. [PMID: 34584242 DOI: 10.1038/s41443-021-00473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Paolo Verze
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.
| | - Mario Belmonte
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Javier Romero Otero
- Department of Urology, Instituto de Investigación Sanitaria Hospital 12 de October (imas12), Hospital Universitario 12 October, Madrid, Spain
| |
Collapse
|
4
|
Chavarriaga J, Prada J, Olejua P, López-Ramos H, Manjarrez M, Silva JM. Complete study for erectile dysfunction (CompED) improving diagnosis and treatment decision-making. Andrologia 2021; 53:e14212. [PMID: 34374105 DOI: 10.1111/and.14212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 01/27/2023] Open
Abstract
Erectile dysfunction is a condition associated with increasing age. Patient evaluation and management should follow a comprehensive, stepwise approach. The aim of this article was to report our experience with the complete study for erectile dysfunction, including intracavernous injection rigidity test, biothesiometry and colour duplex Doppler ultrasound. Data were collected and analysed prospectively. The primary end point was to determine whether treatment decision-making was eased by the CompED test. Secondary end points were to establish which clinical variables prior to the study could impact the results of the CompED test, to finally improve patient selection for the study. 187 patients were recruited, 31.2% of the patients had an axial rigidity below 50%, 28.5% had a peak systolic velocity <25 cm/s, 13.2% had an end-diastolic velocity >5cm/s and 27.5% had an abnormal biothesiometry. The factors that best predicted an abnormal result in any of the tests were age >70 years, IIEF domain A < 14 points, and previous radical prostatectomy or radiotherapy. The CompED test stands as a new alternative for the evaluation of patients with erectile dysfunction, being less time consuming, aiding in a more accurate determination of the aetiology and guiding treatment decision-making.
Collapse
Affiliation(s)
- Julian Chavarriaga
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia.,Division of Urology, Clínica Imbanaco - Quiron Salud, Cali, Colombia
| | - Juan Prada
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Peter Olejua
- Department of Epidemiology and Biostatistics. Hospital, Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Hugo López-Ramos
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Maryori Manjarrez
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José-Miguel Silva
- Division of Urology, Hospital Universitario San Ignacio. Pontificia Universidad Javeriana, Bogotá, Colombia
| |
Collapse
|
5
|
Kamal EE, Ali MEM, Mohamed MZ, Soliman M, El-Mahdy RI, Elsayed A, Badran AY. Relation of pharmacopenile duplex ultrasonography parameters and glycated hemoglobin (HbA1c) in diabetic patients with erectile dysfunction. Rev Int Androl 2020; 20:31-40. [PMID: 33334711 DOI: 10.1016/j.androl.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/22/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Erectile dysfunction (ED) is one of the main threats in diabetic patients. This research aimed to assess the relationship between glycated hemoglobin (HbA1c) level and pharmacopenile duplex ultrasonography (PPDU) indices in diabetic patients with ED. MATERIALS AND METHODS A total of 130 males with ED were recruited (100 had diabetes mellitus (DM) and 30 did not as control). The International Index of Erectile Function (IIEF) was used to evaluate patients for ED. Measurement of HbA1c, lipid profile and assessment of erectile function using PPDU were performed. All participants were assessed to take the medical history. RESULTS The mean age±SD was 53.8±8.9 and 53.6±2.8 years for patients and controls, respectively. Patients had variable grades of ED: mild in 20%, mild to moderate in 32.3%, moderate in 35.3%, and severe in 12.3%. A significant association was found between the existence of DM and a deprived response to intracorporeal injection (ICI), rising end-diastolic velocity (EDV), and reducing resistance index (RI) values. Comparing all diabetic groups according to HbA1c with controls, a significant relationship was found in; severity of IIEF-5 score, poor response to ICI, decreased peak systolic velocity (PSV) at 10min, increased EDV at 10, 20min and decreased RI at 10, 20min. A significant relationship was found between smoking, dyslipidaemia, and decreased PSV at 10, 20min and decreased increment ratio. However, a non-significant relationship was observed between age, type of DM and PPDU parameters. CONCLUSION Poor glycaemic control of DM is associated with an increase in EDV and decrease in RI, and PSV of PPDU.
Collapse
Affiliation(s)
- Emad Eldien Kamal
- Department of Dermatology and Andrology, Faculty of Medicine, Assiut University, Egypt
| | - Mohammed Essam M Ali
- Department of Dermatology and Andrology, Faculty of Medicine, Assiut University, Egypt
| | | | - Mona Soliman
- Department of Internal medicine and endocrinology, Faculty of Medicine, Assiut University, Egypt
| | - Reham I El-Mahdy
- Department of Medical Biochemistry, Faculty of Medicine, Assiut University, Egypt.
| | - Ahmed Elsayed
- Department of Dermatology and Andrology, Faculty of Medicine, Assiut University, Egypt
| | - Aya Y Badran
- Department of Dermatology and Andrology, Faculty of Medicine, Assiut University, Egypt
| |
Collapse
|
6
|
Allaire E, Sussman H, Zugail AS, Hauet P, Floresco J, Virag R. Erectile Dysfunction Resistant to Medical Treatment Caused by Cavernovenous Leakage: An Innovative Surgical Approach Combining Pre-operative Work Up, Embolisation, and Open Surgery. Eur J Vasc Endovasc Surg 2020; 61:510-517. [PMID: 33067110 DOI: 10.1016/j.ejvs.2020.08.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 08/07/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Thirty per cent of cases of erectile dysfunction (ED)/male impotence are resistant to oral treatment. Half of these cases are due to blood drainage from the corpora cavernosa occurring too soon, due to cavernovenous leakage (CVL). The aim of this study was to report on an innovative treatment scheme combining pre- and post-operative haemodynamic assessment, venous embolisation, and open surgery for drug resistant ED caused by CVL. METHODS An analysis of prospectively collected data, with clinical and haemodynamic pre- and post-operative assessment, was carried out. Forty-five consecutive patients operated on for drug resistant ED caused by CVL were evaluated pre-operatively and three months post-operatively by pharmacologically challenged penile duplex sonography (PC-PDS), pharmacologically challenged Erection Hardness Score (PC-EHS), and pharmacologically challenged computed caverno tomography (PC-CCT). Follow up consisted of patient interview, PC-PDS, PC-EHS and if needed PC-CCT. RESULTS Mean patient age was 43.9 ± 12.0 years (range 20-67). Forty-nine per cent of patients had primary ED. Patients with diabetes, a smoking habit, hypercholesterolaemia, and hypertension were 18%, 11%, 9%, and 4%, respectively. Three months post-operatively, PC-EHS increased from 2.0 ± 0.7 to 3.1 ± 0.74 (p < .001), with an EHS of 3 being the threshold allowing for penetration. Deep dorsal vein velocity, a haemodynamic marker of CVL, decreased from 14.2 ± 13.0 to 0.9 ± 3.5 cm/s (p < .001). After a 14.0 ± 10.7 month follow up, the primary success rate (clinical EHS ≥ 3, possible sexual intercourse with penetration, no vascular re-operation, no penile prosthesis implant) was 73.3%. Four patients (9%) underwent successful re-operation for persistent ED and CVL. Accordingly, compared with a possible penetration rate of 8.9% before surgery, 37 patients (secondary success rate: 82.2%) were able to achieve sexual intercourse with penetration. Type of ED (primary vs. secondary) and diabetes had no influence on the results. Thirty-two per cent of patients with secondary success achieved penetration with no medication. CONCLUSIONS After a 14 month follow up, pre-operative work up, embolisation, and open surgery during the same procedure allowed patients with ED resistant to oral medical to achieve intercourse with penetration.
Collapse
Affiliation(s)
- Eric Allaire
- Clinique Geoffroy Saint Hilaire, Groupe Ramsay Générale de Santé, Vascular Surgery Unit, Paris, France; CETI, Paris, France.
| | | | - Ahmed S Zugail
- Clinique Geoffroy Saint Hilaire, Groupe Ramsay Générale de Santé, Vascular Surgery Unit, Paris, France; Clinique Geoffroy Saint Hilaire, Vascular Surgery Unit, Paris, France
| | - Pascal Hauet
- CETI, Paris, France; CRID, 13 Avenue de l'Opéra, Paris, 75001, France
| | | | | |
Collapse
|