Sarteschi L M, Montorsi F, Menchini Fabris F, Guazzoni G, Lencioni R, Rigatti P
Department of Andrology, University of Pisa School of Medicine, Italy.
J Urol. 1998 Feb;159(2):428-32. doi: 10.1016/s0022-5347(01)63941-7.
We assessed the morphodynamic features of cavernous arteries and helicine arterioles by power Doppler sonography in vasculogenic and nonvasculogenic impotent men.
A total of 40 impotent patients with and without definite vascular risk factors were studied by penile power Doppler sonography. The test was performed during penile flaccidity, after intracavernous injection of 20 mcg. alprostadil and after subsequent genital and audiovisual sexual stimulation. A second injection and stimulation were given if the erectile response observed after the initial injection was less than the maximum erection seen during sexual activity. Morphodynamic parameters evaluated by power Doppler imaging included vessel course, shape, wall thickness and pulsatility, peak systolic velocity, end diastolic velocity, acceleration time and resistance index.
In the nonvasculogenic group all patients who achieved rigid erection showed normal cavernosal artery and helicine arteriole inflow. In these cases the arteriolar picture was characterized by the presence of 3 orders of distal ramifications originating from the cavernous arteries with an acute angle, systolic diastolic flow during penile tumescence and systolic flow alone at full rigidity. In the vasculogenic group patients with normal cavernous artery inflow showed an arteriolar tree that was pathological in 50% and was characterized by a reduced number of ramifications originating perpendicularly from the cavernous arteries and irregular caliber (arteriolar impotence). In the same group patients with reduced cavernous artery inflow also showed normal or pathological arteriolar components (pre-penile arterial impotence and diffused penile arterial impotence).
Power Doppler sonography allows a precise study of the morphodynamics of the cavernous arteries and helicine arterioles. Our preliminary data suggest that the intracavernous arteriolar component may have a significant role in the genesis of some forms of vasculogenic impotence.
我们通过能量多普勒超声评估血管性和非血管性阳痿男性海绵体动脉和螺旋小动脉的形态动力学特征。
对40例有或无明确血管危险因素的阳痿患者进行阴茎能量多普勒超声检查。检查在阴茎疲软状态下、海绵体内注射20微克前列地尔后以及随后的生殖器和视听性刺激后进行。如果初次注射后观察到的勃起反应小于性活动期间所见的最大勃起，则进行第二次注射和刺激。通过能量多普勒成像评估的形态动力学参数包括血管走行、形状、壁厚和搏动性、收缩期峰值流速、舒张末期流速、加速时间和阻力指数。
在非血管性组中，所有达到坚硬勃起的患者均显示海绵体动脉和螺旋小动脉血流正常。在这些病例中，小动脉图像的特征是存在3级远端分支，这些分支以锐角从海绵体动脉发出，阴茎肿胀时有收缩期和舒张期血流，完全勃起时仅有收缩期血流。在血管性组中，海绵体动脉血流正常的患者显示小动脉树有50%为病理性，其特征是从海绵体动脉垂直发出的分支数量减少且管径不规则（小动脉性阳痿）。在同一组中，海绵体动脉血流减少的患者也显示小动脉成分正常或病理性（阴茎前动脉性阳痿和弥漫性阴茎动脉性阳痿）。
能量多普勒超声可精确研究海绵体动脉和螺旋小动脉的形态动力学。我们的初步数据表明，海绵体内小动脉成分可能在某些形式的血管性阳痿的发生中起重要作用。
