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Review
. 2021 Sep;9(5):1457-1466.
doi: 10.1111/andr.13029. Epub 2021 May 27.

The penile duplex ultrasound: How and when to perform it?

Antonio Aversa  1 , Andrea Crafa  2 , Emanuela Alessandra Greco  3 , Eusebio Chiefari  3 , Antonio Brunetti  3 , Sandro La Vignera  2
Affiliations
Free article
Review

The penile duplex ultrasound: How and when to perform it?

Antonio Aversa et al. Andrology. 2021 Sep.
Free article

Abstract

Background: Because it is a superficial structure, the penis is ideally suited to ultrasound imaging. A number of disease processes, including Peyronie's disease, penile fractures and tumors, are clearly visualized with ultrasound. Baseline and dynamic assessment of cavernosal arterial changes after pharmaco-stimulation with alprostadil allows standardized diagnosis of arterial and venogenic causes of erectile dysfunction (ED).

Objective: To illustrate how to correctly perform flaccid and dynamic penile duplex ultrasound (D-PDU) and in which patients to recommend it.

Materials/methods: An extensive search of the literature was carried out on Pubmed with the insertion of the following Medical Subjects Headings (MeSH) terms and keywords "penile color Doppler ultrasound" "peak systolic velocity" "end-diastolic velocity", "acceleration time", "resistance index".

Evidence: In our experience, arterial erectile dysfunction is identified after standardized intracavernous injection (ICI) of alprostadil (10 mcg) when values of peak systolic velocity (PSV) are <35 cm/s and, in the most severe forms, for values <25 cm/s. Arterial insufficiency can also be identified by increased acceleration time (AT) values (>110 ms) and/or by a lack of visualization of helicine arteries at power Doppler mode along with incomplete achievement of penile rigidity. The veno-occlusive incompetence is determined when end-diastolic velocity (EDV) values are >4.5-5 cm/s or in the case of resistance index (RI) values <0.75. The assessment of additional surrogate markers of endothelial dysfunction, that is, intima-media thickness, mean platelet volume (MPV), endothelial progenitor cells (EPC), endothelial cell specific molecule-1(endocan) are also useful in assessing the patient's cardiovascular risk but are still considered investigational in the interpretation of D-PDU results.

Conclusion: D-PDU scan after ICI with vasoactive drugs is a safe procedure and represents the gold standard for the diagnostics of penile pathologies and should be performed in men with ED not responding to oral conventional therapies and/or in those requiring accurate stratification of cardiovascular risk.

Keywords: penis; pharmaco-stimulation; sonography; vascular imaging.

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References

REFERENCES

    1. Aversa A, Sarteschi LM. The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. J Sex Med. 2007;4(5):1437-1447.
    1. Leriche R, Morel A. The syndrome of thrombotic obliteration of aortic bifurcation. Ann Surg. 1948;127:193-220.
    1. Nashed A, Lokeshwar SD, Frech F, Mann U, Patel P. The efficacy of penile duplex ultrasound in erectile dysfunction management decision-making: a systematic review. Sex Med Rev. 2020. Online ahead of print. https://doi.org/10.1016/j.sxmr.2020.10.006
    1. Isidori AM, Corona G, Aversa A, et al. The SIAMS-ED trial: a national, independent, multicentre study on cardiometabolic and hormonal impairment of men with erectile dysfunction treated with vardenafil. Int J Endocrinol. 2014;2014:858715.
    1. Aversa A, Isidori AM, Caprio M, Cerilli M, Frajese V, Fabbri A. Penile pharmacotesting in diagnosing male erectile dysfunction: evidence for lack of accuracy and specificity. Int J Androl. 2002;25:6-10.

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