Department of Experimental and Clinical Medicine, University "Magna Graecia", Catanzaro, Italy.
Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
Andrology. 2021 Sep;9(5):1457-1466. doi: 10.1111/andr.13029. Epub 2021 May 27.
Because it is a superficial structure, the penis is ideally suited to ultrasound imaging. A number of disease processes, including Peyronie's disease, penile fractures and tumors, are clearly visualized with ultrasound. Baseline and dynamic assessment of cavernosal arterial changes after pharmaco-stimulation with alprostadil allows standardized diagnosis of arterial and venogenic causes of erectile dysfunction (ED).
To illustrate how to correctly perform flaccid and dynamic penile duplex ultrasound (D-PDU) and in which patients to recommend it.
MATERIALS/METHODS: An extensive search of the literature was carried out on Pubmed with the insertion of the following Medical Subjects Headings (MeSH) terms and keywords "penile color Doppler ultrasound" "peak systolic velocity" "end-diastolic velocity", "acceleration time", "resistance index".
In our experience, arterial erectile dysfunction is identified after standardized intracavernous injection (ICI) of alprostadil (10 mcg) when values of peak systolic velocity (PSV) are <35 cm/s and, in the most severe forms, for values <25 cm/s. Arterial insufficiency can also be identified by increased acceleration time (AT) values (>110 ms) and/or by a lack of visualization of helicine arteries at power Doppler mode along with incomplete achievement of penile rigidity. The veno-occlusive incompetence is determined when end-diastolic velocity (EDV) values are >4.5-5 cm/s or in the case of resistance index (RI) values <0.75. The assessment of additional surrogate markers of endothelial dysfunction, that is, intima-media thickness, mean platelet volume (MPV), endothelial progenitor cells (EPC), endothelial cell specific molecule-1(endocan) are also useful in assessing the patient's cardiovascular risk but are still considered investigational in the interpretation of D-PDU results.
D-PDU scan after ICI with vasoactive drugs is a safe procedure and represents the gold standard for the diagnostics of penile pathologies and should be performed in men with ED not responding to oral conventional therapies and/or in those requiring accurate stratification of cardiovascular risk.
由于阴茎是一种表浅结构，因此非常适合超声成像。许多疾病过程，包括 Peyronie 病、阴茎骨折和肿瘤，都可以通过超声清晰地显示出来。在使用前列地尔进行药物刺激后，对海绵体动脉变化进行基线和动态评估，可以标准化诊断动脉和静脉性勃起功能障碍（ED）的原因。
说明如何正确进行疲软和动态阴茎双功能超声（D-PDU）检查，并在哪些患者中推荐使用。
材料/方法：在 Pubmed 上进行了广泛的文献搜索，并插入了以下医学主题词（MeSH）术语和关键词：“阴茎彩色多普勒超声”“收缩期峰值速度”“舒张末期速度”“加速时间”“阻力指数”。
根据我们的经验，在标准化阴茎海绵体内注射（ICI）前列地尔（10 mcg）后，如果收缩期峰值速度（PSV）值<35 cm/s，在最严重的情况下，<25 cm/s，则可识别动脉性勃起功能障碍。加速时间（AT）值升高（>110 ms）和/或在功率多普勒模式下无法观察到螺旋动脉，以及阴茎硬度不完全达到时，也可以识别动脉功能不全。当舒张末期速度（EDV）值>4.5-5 cm/s 或阻力指数（RI）值<0.75 时，可确定静脉阻塞性功能不全。评估内皮功能障碍的其他替代标志物，即内膜-中层厚度、平均血小板体积（MPV）、内皮祖细胞（EPC）、内皮细胞特异性分子-1（endocan），也有助于评估患者的心血管风险，但在解释 D-PDU 结果时仍被认为是研究性的。
ICI 后使用血管活性药物进行 D-PDU 扫描是一种安全的程序，是阴茎病变诊断的金标准，应在对口服常规治疗无反应的 ED 男性中进行，和/或在需要准确分层心血管风险的男性中进行。
