The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction.

INTRODUCTION: In the era of orally active agents, dynamic penile color-duplex ultrasound (D-PCDU) is not considered a necessary first screening for all patients with erectile dysfunction (ED). Various parameters, such as peak systolic flow velocity, end diastolic velocity, resistance index, acceleration time, and degree of arterial dilatation, have been suggested for the diagnosis of vascular ED by D-PCDU. AIM: To highlight the clinical utility and evidence-based interpretation of D-PCDU criteria. METHODS: Extensive, unsystematic PubMed literature search reviewing relevant data on D-PCDU in the evaluation of male ED. RESULTS: The advantage of ultrasound is the minimally invasive nature of the procedure and the ability to screen patients to identify a normal arterial response of cavernous arteries. Men with sexual dysfunctions above 55 years of age and comorbidities are more likely to have multi-organ vascular dysfunction and may necessitate further testing because erectile failure may be the first presenting symptom requiring investigation and treatment even in the absence of cardiovascular risk factors. All patients affected with Peyronie's disease and younger men with persistent ED, a history of pelvic traumas, or fractures of the penile shaft should be offered ultrasonographic penile blood flow studies before referral to surgery or more invasive vascular investigations. CONCLUSIONS: In the near future, D-PCDU may be used in preference to patients presenting with or without vascular risk factors, particularly those not responding to first-line orally active drugs and seeking an explanation as to why these agents failed.

[Echo-color-Doppler in male pelvic congestion syndrome]. / L'eco-color-Doppler nella sindrome da congestione pelvica maschile.

The pelvic congestion syndrome has been widely studied in the female sex, while there are not many publications on the male equivalent. Prostatitis represent the most frequent affections of the genito-urinary male tract that require the urologic consult, but in the majority of the cases the etiology of such affections remains unknown. Some forms of microscopic hematuria or macroscopic hematuria are also cryptogenetic. Varicocelectomy is widely given in the infertile patients, but not always the intervention achieves a recovery of the semen quality. In this work we revisit the anatomy of the pelvic male venous drain and we depict its objective findings with the echo-color-Doppler sonography (ECD). The purpose of the study is to encourage a polycentric uro-andrologic search on large numbers, with the goal of resolve if the ECD pictures of congestion pelvic syndrome could have relation with some "prostatitis syndromes", with some cryptogenetic hematuria and/or with the prognosis of the infertile patients undergone to varicocelectomy.

[Comparison of renal ultrasonographic and functional biometry in healthy patients and in patients with chronic renal failure]. / Confronto tra biometria ecografica e funzionale renale in pazienti sani e in pazienti con IRC.

OBJECTIVE: The purpose of this study, that examined healthy adult subjects and nephropatic patients, was to detect some relations between kidney's sonographic dimensions and renal function, expressed by creatinine clearance to evaluate more significant and useful sonographic parameters for the follow-up of nephropathies. SUBJECTS AND METHODS: Age, sex, body weight, height, body mass index, creatinine clearance were evaluated in 15 healthy and in 32 nephropathic subjects. In those subjects length, width, and thickness of the kidney and its central echogenic area and the parenchimal thickness of the upper pole were measured by ultrasonographic technique. Measurements were made with the patients in supine/oblique position. Renal shape index, parenchimal volume of the kidney and volume of the central echogenic area were calculated. Renal dimensions were correlated with age, total body area, body mass index and creatinine clearance. The patients, according to creatinine clearance, were divided into three classes: Class 1 Creatinine Clearance > 70 ml/min Class 2 Creatinine Clearance > 30 < 70 ml/min Class 3 Creatinine Clearance < 30 > 10 ml/min RESULTS: The renal length, as renal failure progressed significantly decreased until creatinine clearance = 30 ml/min. In class 3 the renal volume and the transvers diameter decreased as renal failure progressed. The renal parenchymal volume as renal failure progressed significantly decreased. Our results demonstrated that renal length reduced inside the three classes of patients but the reduction was significant only between the first and the second classes of patients. The transverse diameter and the renal shape index did not reduce significantly inside three classes of patients. The renal parenchimal volume reduced significantly inside the 3 classes. CONCLUSIONS: The more important measurement of renal size is longitudinal diameter in subjects with normal renal function. However, the renal parenchimal volume is the more exact sonographic parameter in end-stage renal failure.