Chiou R K, Pomeroy B D, Chen W S, Anderson J C, Wobig R K, Taylor R J
Section of Urologic Surgery, University of Nebraska Medical Center, Omaha, USA.
J Urol. 1998 Jan;159(1):109-12. doi: 10.1016/s0022-5347(01)64028-x.
Penile erection is achieved through hemodynamic mechanisms that can be assessed best with color flow imaging and Doppler waveform analysis. We performed dynamic studies using computer assisted analysis to assess the hemodynamic patterns of pharmacologically induced erection.
A total of 73 color Doppler ultrasound studies was performed in 66 patients with erectile dysfunction. Various blood flow parameters, including peak systolic velocity, end diastolic velocity, mean flow rate, resistive index and artery diameter, were observed continuously and recorded frequently for about 30 minutes after intracorporeal injection of papaverine/phentolamine/prostaglandin E1 mixture. A computerized Doppler waveform analysis of 3 curves or greater was performed for each recording to minimize error. A second injection was administered if the first injection failed to induce a rigid erection. Status of the erection was observed and recorded throughout the study. A computerized graph was generated for each corpus.
After intracorporeal injection the time to reach normal or peak velocity varied from 1 to 24 minutes. Among 146 corpus units in 73 color Doppler ultrasound studies we observed the following hemodynamic patterns: I-normal maximal peak systolic velocity (35 cm. per second or greater), sustained; Ia-end diastolic velocity 0 or less with complete erection response (19 units); Ib-end diastolic velocity greater than 0 or incomplete erection response (14 units); II-normal maximal peak systolic velocity (35 cm. per second or greater), transient; IIa-end diastolic velocity 0 or less with complete erection response (21 units); IIb-end diastolic velocity greater than 0 or incomplete erection response (12 units); III-borderline maximal peak systolic velocity (30 to 35 cm. per second); IIIa-end diastolic velocity 0 or less with complete erection response (10 units); IIIb-end diastolic velocity greater than 0 or incomplete erection response (8 units); IV-low maximal peak systolic velocity (less than 30 cm. per second); IVa-end diastolic velocity 0 or less with complete erection response (24 units); and IVb-end diastolic velocity greater than 0 or incomplete erection response (38 units).
Erection is a complex and dynamic process. A new classification of hemodynamic patterns is presented that aids in assessing and interpreting more thoroughly blood flow parameters to stratify more precisely the hemodynamic patterns of erectile dysfunction.
阴茎勃起通过血流动力学机制实现，而彩色血流成像和多普勒波形分析能对其进行最佳评估。我们采用计算机辅助分析进行动态研究，以评估药物诱导勃起的血流动力学模式。
对66例勃起功能障碍患者共进行了73次彩色多普勒超声检查。在海绵体内注射罂粟碱/酚妥拉明/前列腺素E1混合剂后，持续观察并频繁记录包括收缩期峰值流速、舒张末期流速、平均流速、阻力指数和动脉直径在内的各种血流参数，持续约30分钟。对每次记录进行3条或更多曲线的计算机化多普勒波形分析，以尽量减少误差。若首次注射未能诱导出坚硬勃起，则进行第二次注射。在整个研究过程中观察并记录勃起状态。为每个海绵体生成一张计算机化图表。
海绵体内注射后，达到正常或峰值流速的时间为1至24分钟。在73次彩色多普勒超声检查的146个海绵体单位中，我们观察到以下血流动力学模式：I型 - 正常最大收缩期峰值流速（每秒35厘米或更高），持续；Ia型 - 完全勃起反应时舒张末期流速为0或更低（19个单位）；Ib型 - 完全勃起反应时舒张末期流速大于零或勃起反应不完全（14个单位）；II型 - 正常最大收缩期峰值流速（每秒35厘米或更高），短暂；IIa型 - 完全勃起反应时舒张末期流速为0或更低（21个单位）；IIb型 - 完全勃起反应时舒张末期流速大于零或勃起反应不完全（12个单位）；III型 - 临界最大收缩期峰值流速（每秒30至35厘米）；IIIa型 - 完全勃起反应时舒张末期流速为0或更低（10个单位）；IIIb型 - 完全勃起反应时舒张末期流速大于零或勃起反应不完全（8个单位）；IV型 - 低最大收缩期峰值流速（低于每秒30厘米）；IVa型 - 完全勃起反应时舒张末期流速为0或更低（24个单位）；IVb型 - 完全勃起反应时舒张末期流速大于零或勃起反应不完全（38个单位）。
勃起是一个复杂的动态过程。提出了一种新的血流动力学模式分类方法，有助于更全面地评估和解释血流参数，从而更精确地对勃起功能障碍的血流动力学模式进行分层。
