Sonography of the penis/erectile dysfunction.

Erectile dysfunction (ED) is defined as the persistent inability to achieve and/or maintain an erection for a satisfactory sexual activity. It is secondary to several organic, psychogenic, and combined causes, and represents a serious health dilemma affecting both men and their partners. The diagnostic approach to erectile dysfunction has significantly changed in the last years with the advent of phosphodiesterase-5 (PDE5) inhibitors, and with the recognition that surgical treatment of both arterial insufficiency and penile venous leak have poor long-term clinical outcomes. Although imaging modalities have diminished in importance, differentiating among causes of erectile dysfunction remains mandatory in good medical practice, and ultrasound (US) still remains the cornerstone of the diagnostic workup. US provides an objective, minimally invasive evaluation of penile hemodynamics. Moreover, it provides an excellent depiction of the penile anatomy and of its changes in pathological conditions such as in patients with Peyronie's disease, priapism, and posttraumatic erectile dysfunction.

Therapeutic Effectiveness of the Superselective Arterial Gelfoam Embolization in Post-traumatic ArterialPriapism

PURPOSE: We retrospectively evaluated superselective embolization with Gelfoam for the management ofpost-traumatic arterial priapism. MATERIALS AND METHODS: Six male patients with post-traumatic priapism underwentpudendal angiography and embolization. We evaluated the time and incidence of detumescence after embolization andcompared normal erectile function and its duration with the results of other reports. In all patients, colorDoppler sonography was performed pre- and post-angiographically. RESULTS: On pudendal arteriography,intracavernosal arteriovenous fistulas were observed in all patients, and pseudoaneurysm of the cavernosal artery(or common penile artery) in three. Detumescence and normal erec-tile function were achieved in all patients aftersuperselective embolization. Using color Doppler sonography, the location of the lesion causing priapism wasfound, in four patients, to be the proximal or middle one-third of the cavernosal artery. CONCLUSION: Pudendalangiography with superselective embolization with Gelfoam is a safe and effective method for the correction ofpost-traumatic arterial priapism.

Diagnostic Value of Double Injection of Vasoactive Drug in Penile Doppler Ultrasonography

PURPOSE: To evaluate the usefulness of double injection of a vasoactive drug in penile Doppler ultrasonography for the diagnosis of vasculogenic impotence. MATERIALS AND METHODS: Eighty-four consecutive cases (bilateral sides) of 42 patients with suspected vasculogenic impotence were included in our study. We used computed sonography (Acuson, USA), with a 7 MHz linear array transducer. After the first intracavernosal injection of the vasoactive drug (10 ug of prostagladin E1), peak systolic velocity (PSV) and end diastolic velocity (EDV) were measured three times. According to mean PSV and EDV, the patients were classified into four groups : arteriogenic impotence (AI;N=29), venogenic impotence (VI;N=28), AI associated with VI(N=14), and normal(N=13).After the second injection, PSV and EDV were remeasured, using the same method. Mean velocities of the first injection were compared with those of the second, and the paired t-test was used to analyze the results. the extent to which patients were reclassified after the scecond injection we noted. RESULTS: In all four groups, PSV measured after the second injection was significantly different from PSV after the first (p=0.0001, 0.0001, 0.0010, 0.0072); except in the normal group, EDV measured after the second injection was not different from EDV after the first (P=0.9815, 0.0654, 0.0950, 0.0057). After the second injection, the numbers of patients reclassified into other groups were as follows : AI, 11 (38%); VI, 6 (21%); AI associated with VI, 11 (79%); normal, 1 (8%). CONCLUSION: Double injection of a vasoactive drug affected PSV, and therefore, appears to be a useful adjunctive procedure for the evaluation of patients in whom classification based on the results of the first injection is difficult.

Post-traumatic Arterial Priapism: Doppler Ultrasonographic Findings and Therapeutic Embolization

Two cases of post-traumatic arterial priapism diagnosed with duplex and color Doppler ultrasonography showed pseudoaneurysm and increased peak systolic and diastolic velocity of the inflowing cavernosal artery(low resistance index). An autologous blood clot successfully controlled tumescence and was comfortable and secure in preventing necrosis and impotence.