Govier F E, Asase D, Hefty T R, McClure R D, Pritchett T R, Weissman R M
Department of Urology and Renal Transplantation, Virginia Mason Medical Center, Seattle, Washington, USA.
J Urol. 1995 May;153(5):1472-5.
Duplex ultrasonography is an accepted method to assess noninvasively arterial inflow to the penis. Optimal pharmacological agents as well as timing of the scan and stimulation during the scan continue to be debated. In an effort to achieve a more complete smooth muscle relaxation and capture what we perceived was a wide variation in interval to maximum arterial velocity, we revised our duplex protocol in January 1991. We report on 280 consecutive patients evaluated in this manner. Patients received 0.25 or 0.5 cc of a triple drug mixture containing 22.5 mg./cc papaverine, 0.83 mg./cc phentolamine and 8.33 micrograms/cc prostaglandin E1. Scans were performed at 0, 5, 15 and 30 minutes after injection in all patients. Any patient not having a full erection at 15 minutes performed private self-stimulation while in the standing position for at least 5 minutes before the 30-minute scan. If we conservatively define normal arterial inflow as a peak Doppler velocity of 25 cm. per second or greater in the best artery, only 35% of our patients achieved this velocity at 5 minutes. Of the remainder 26% and 22% did not reach normal velocity values until 15 and 30 minutes, respectively, after the injection. By delaying initial measurements of velocity until 5 minutes, could the highest inflow velocity be missed and patients diagnosed incorrectly? The group at risk would be those who had good tumescence at 5 minutes and who had presumably already decreased the inflow velocities. Of the 280 patients 74 (26%) had greater than 10% tumescence at 5 minutes. Only 6 of these 74 patients did not reach velocities of 25 cm. per second or more in the best artery at some time during their study. In conclusion, our study clearly supports delaying the initial scan until 5 minutes, since only 6 of our 280 patients (2.1%) may have been incorrectly diagnosed. The study also strongly argues for additional scans until 30 minutes and self-stimulation when necessary.
双功超声检查是一种公认的无创评估阴茎动脉血流的方法。最佳的药物、扫描时间以及扫描过程中的刺激方式仍存在争议。为了实现更完全的平滑肌松弛，并捕捉我们所认为的达到最大动脉速度的时间间隔的广泛差异，我们于1991年1月修订了双功检查方案。我们报告了以这种方式评估的280例连续患者的情况。患者接受了0.25或0.5毫升含有22.5毫克/毫升罂粟碱、0.83毫克/毫升酚妥拉明和8.33微克/毫升前列腺素E1的三联药物混合物注射。所有患者在注射后0、5、15和30分钟进行扫描。在15分钟时未完全勃起的任何患者，在30分钟扫描前，需在站立位进行至少5分钟的自我刺激。如果我们保守地将正常动脉血流定义为最佳动脉的峰值多普勒速度为每秒25厘米或更高，那么在5分钟时只有35%的患者达到了这个速度。其余患者中，分别有26%和22%直到注射后15分钟和30分钟才达到正常速度值。通过将速度的初始测量推迟到5分钟，会不会错过最高的血流速度并错误地诊断患者呢？有风险的群体将是那些在5分钟时有良好勃起且可能已经降低了血流速度的患者。在280例患者中，74例（26%）在5分钟时勃起超过10%。在这74例患者中，只有6例在研究期间的某个时间，最佳动脉的速度未达到每秒25厘米或更高。总之，我们的研究明确支持将初始扫描推迟到5分钟，因为在我们的280例患者中只有6例（2.1%）可能被错误诊断。该研究还强烈主张进行额外的扫描，直到30分钟，并在必要时进行自我刺激。
