Sexual and Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
J Sex Med. 2024 Aug 1;21(8):734-739. doi: 10.1093/jsxmed/qdae070.
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.
We herein describe the PDUS protocol used at our center, including indications, technique, and data interpretation.
We describe our institutional experience with PDUS and discuss it in the context of a contemporary review of the literature for this investigation.
Our institutional PDUS protocol.
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.
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.
血管性勃起功能障碍是最常见的勃起功能障碍类型，阴茎多普勒超声（PDUS）是评估勃起血流动力学的有用工具，可帮助临床医生与患者讨论预后和管理策略。
我们在此描述了我们中心使用的 PDUS 方案，包括适应证、技术和数据解读。
我们描述了我们在 PDUS 方面的机构经验，并在当代文献综述的背景下对此进行了讨论。
我们的机构 PDUS 方案。
为了正确进行 PDUS，充分的培训、设备、环境、技术和解读至关重要。PDUS 的准确性完全取决于是否能实现完全的海绵体平滑肌松弛。再给药方案可优化 PDUS 期间获得的血流动力学数据的可靠性和可重复性。进行基于硬度的评估，并根据患者达到的勃起硬度（完全硬度）或给予最大剂量的血管活性药物对患者进行扫描。收缩期峰值速度被视为动脉流入的衡量标准（正常，>30cm/s），而舒张末期速度评估静脉闭塞机制（正常，<5cm/s）。操作完成后，评估患者以确认消退。如果患者有持续的穿透硬度勃起，可给予阴茎内苯肾上腺素；但是，如果单独使用阴茎内苯肾上腺素注射不能达到消退，则可能进行阴茎海绵体抽吸。
PDUS 是评估勃起血流动力学的一种有价值的微创工具，如果能实现完全的海绵体平滑肌松弛，则可以进行准确评估。
