Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL60611-3008, USA.
J Sex Med. 2010 Mar;7(3):1262-8. doi: 10.1111/j.1743-6109.2009.01649.x. Epub 2010 Jan 6.
Penile vascular abnormalities occur in a high proportion of patients with Peyronie's disease (PD). Penile duplex ultrasonography (PDU) and dynamic infusion cavernosometry and cavernosography (DICC) are tools that can be used to help tailor individualized treatment for patients undergoing surgical intervention for their PD. However, precisely which parameters can be used to predict those patients with PD at risk for developing erectile dysfunction (ED) after intervention without inflatable penile prosthesis (IPP) has not been previously elucidated.
To evaluate preoperative vascular parameters that predispose PD patients for developing ED after intervention without IPP.
Twenty-six patients receiving surgical intervention for their PD at a single center were retrospectively identified. Of these, 11 (42.3%) opted for primary repair without placement of an IPP. Three (27.2%) of these 11 patients went on to develop ED postoperatively.
We compared various demographic, PDU, and DICC parameters between patients who did and did not fail primary repair of their PD.
Mean age and follow-up of patients who went on to develop ED after repair of PD without IPP were not significantly different (P < 0.05). Resistive index (RI) and end diastolic volume were significantly different between these two groups (P < 0.05), while peak systolic volume, flow to maintain, and pressure decay were not significantly different. An RI cutoff of <0.80 was found to identify all patients who would later develop ED and fail primary repair without IPP.
Penile vascular assessment can aid in counseling patients about their risk of developing delayed ED after primary repair of PD. In our cohort of patients, PDU provided preoperative risk stratification for postoperative erectile dysfunction in men undergoing Peyronie's repair without IPP. We propose the prospective study of an RI cutoff to identify patients at risk of failing primary PD repair without IPP.
在很大比例的 Peyronie 病（PD）患者中存在阴茎血管异常。阴茎双功能超声（PDU）和动态静脉注射海绵体造影和海绵体照相术（DICC）是可用于帮助针对接受手术干预的患者制定个体化治疗方案的工具。然而，以前尚未阐明哪些参数可以用于预测那些在没有可膨胀性阴茎假体（IPP）的情况下接受 PD 手术干预后发生勃起功能障碍（ED）的风险。
评估术前血管参数，预测 PD 患者在没有 IPP 的情况下接受手术干预后发生 ED 的风险。
回顾性地在一家中心确定了 26 名接受 PD 手术干预的患者。其中，11 名（42.3%）选择不放置 IPP 进行原发性修复。这 11 名患者中有 3 名（27.2%）术后发生 ED。
我们比较了在 PD 原发性修复失败和成功的患者之间各种人口统计学、PDU 和 DICC 参数。
接受 PD 无 IPP 原发性修复后发生 ED 的患者的平均年龄和随访时间无显著差异（P < 0.05）。两组之间的阻力指数（RI）和舒张末期容积有显著差异（P < 0.05），而峰值收缩容积、维持流量和压力衰减没有显著差异。发现 RI ＜0.80 的截断值可识别所有随后发生 ED 并无法进行无 IPP 原发性修复的患者。
阴茎血管评估可以帮助患者了解在 PD 原发性修复后发生迟发性 ED 的风险。在我们的患者队列中，PDU 为无 IPP 的 PD 修复术后发生勃起功能障碍的男性提供了术前风险分层。我们建议前瞻性研究 RI 截断值，以识别无法进行无 IPP 的原发性 PD 修复的患者。
