Naroda T, Yamanaka M, Matsushita K, Kimura K, Kawanishi Y, Numata A, Yuasa M, Tamura M, Kagawa S
Department of Urology, Takamatsu Red Cross Hospital, Japan.
Nihon Hinyokika Gakkai Zasshi. 1996 Nov;87(11):1231-5. doi: 10.5980/jpnjurol1989.87.1231.
Pharmaco-dynamic infusion cavernosometry and cavernosography (pharmaco-DICC) is essential for diagnosis of venogenic impotence, however it is so invasive. On the other hand, color Doppler ultrasonography is non-invasive and has become one of the useful diagnostic methods for arteriogenic impotence. And there are some reports evaluating whether venogenic impotence can be diagnosed using color Doppler ultrasonography. In this study, we investigated whether the resistance index (RI) could be useful for screening for venogenic impotence.
We performed color Doppler ultrasonography in 49 patients who had shown negative responses to an intracavernous injection of 20 mcg of prostaglandin E1 (PGE1). They previously underwent pharmaco-DICC and were diagnosed venogenic impotent when the maintenance flow rate was equal to or more than 20 ml/min. In 49 patients, 17 patients had DICC normality, while 32 patients had corporal leakages. After an intracavernous injection of 20 mcg of PGE1, we performed color Doppler ultrasonography, and measured peak systolic velocity (PSV) and end diastolic velocity (EDV) in the cavernous artery. RI was calculated as follows. RI = (PSV-EDV)/PSV We adopted the RI value near to 1 as the case's RI from two RI values of bilateral cavernous arteries, and compared RI values with the results of pharmaco-DICC.
RI range in patients with normal DICC results was 0.895 +/- 0.092 (0.70-1.00), while RI range in patients with corporal leakages was 0.742 +/- 0.095 (0.55-0.97). RI values in patients with corporal leakages were significantly lower than those in patients with normal DICC results although there was some overlap in each group. From receiver-operating-characteristic curve (ROC curve) of the correlation between sensitivity and specificity at various RI values compared with DICC results, the RI cut off values were set up at 0.75 and 0.90, and classified the patients into 3 group according to their RI cut off values. In 10 patients with 0.9 < RI, 9 patients (90%) had DICC normality. In 17 patients with 0.75 < RI < or = 0.9, 7 patients had DICC normality while 10 patients had corporal leakages. In 22 patients with RI < or = 0.75, 21 patients (95.5%) had corporal leakages.
We consider without carrying out pharmaco-DICC that patients with 0.9 < RI were not venogenic impotent, while patients with RI < or = 0.75 had corporal leakages. Pharmaco-DICC will remain essential only in patients with 0.75 < RI < or = 0.9.
药物动力学海绵体测压与海绵体造影（药物动力学-DICC）对于静脉性阳痿的诊断至关重要，然而其具有侵入性。另一方面，彩色多普勒超声检查是非侵入性的，已成为动脉性阳痿的有用诊断方法之一。并且有一些报告评估是否可以使用彩色多普勒超声检查来诊断静脉性阳痿。在本研究中，我们调查了阻力指数（RI）是否有助于筛查静脉性阳痿。
我们对49例阴茎海绵体内注射20微克前列腺素E1（PGE1）后反应阴性的患者进行了彩色多普勒超声检查。他们之前接受过药物动力学-DICC检查，当维持流速等于或超过20毫升/分钟时被诊断为静脉性阳痿。在这49例患者中，17例DICC结果正常，而32例存在海绵体渗漏。阴茎海绵体内注射20微克PGE1后，我们进行了彩色多普勒超声检查，并测量了海绵体动脉的收缩期峰值流速（PSV）和舒张末期流速（EDV）。RI的计算方法如下。RI =（PSV - EDV）/ PSV我们从双侧海绵体动脉的两个RI值中选取接近1的RI值作为该病例的RI，并将RI值与药物动力学-DICC的结果进行比较。
DICC结果正常的患者RI范围为0.895±0.092（0.70 - 1.00），而存在海绵体渗漏的患者RI范围为0.742±0.095（0.55 - 0.97）。存在海绵体渗漏的患者的RI值显著低于DICC结果正常的患者，尽管每组之间存在一些重叠。根据与DICC结果相比不同RI值时敏感性和特异性之间相关性的受试者操作特征曲线（ROC曲线），将RI截断值设定为0.75和0.90，并根据RI截断值将患者分为3组。在RI＞0.9的10例患者中，9例（90%）DICC结果正常。在0.75＜RI≤0.9的17例患者中，7例DICC结果正常，而10例存在海绵体渗漏。在RI≤0.75的22例患者中，21例（95.5%）存在海绵体渗漏。
我们认为，在不进行药物动力学-DICC检查的情况下，RI＞0.9的患者不是静脉性阳痿，而RI≤0.75的患者存在海绵体渗漏。仅在0.75＜RI≤0.9的患者中，药物动力学-DICC检查仍然必不可少。
