The Penile Blood Flow Study: Evaluation of Vasculogenic Impotence by Duplex Ultrasonography

  • G. A. Broderick
  • T. F. Lue

Abstract

Erection is a complex vascular event governed by the integrity of smooth muscle in the arteriolar walls and trabeculae of the corpora cavernosa. In the flaccid state the arteries, arterioles, and sinusoids are contracted with free flow through the emissary veins which exit through the tunica albuginea. Neurotransmitters and local modulators like endothelium-relaxant factor released during sexual stimulation result in smooth muscle relaxation, increase in arterial flow, and sinusoidal compliance. Blood distends the sinusoids, which in turn compress the subtunical venular plexus and reduce the outflow. About 90% of systolic pressure is transmitted to the sinusoidal spaces converting the flaccid shaft into the erect penis [2, 26]. The introduction of intracavernous vasoactive agents by Virag [27] and Brindley [8] has further improved our current understanding of erectile function. Clinical studies based on intracavernous vasoactive agents such as papaverine, phentolamine, prostaglandin El (PGE1) and vasoactive intestinal polypeptide (VIP) have revealed that impotence is most often organic in origin and predominantly vasculogenic in etiology [28, 29]. We believe that high resolution ultrasonography and pulsed Doppler spectrum analysis following erection induced by intracorporeal injection is the most reliable and least invasive means of detecting arteriogenic erectile failure and selecting patients for more invasive tests. We have combined our clinical experience with the Doppler penile blood flow study (PBFS) following intracavernous injection of papaverine or prostaglandin El in more than 1500 cases, and from this we have generated a set of parameters for diagnosing arteriogenic impotence. The principles, techniques, and criteria of the Doppler PBFS will be reviewed.

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References

  1. 1.
    Abelson D (1975) Diagnostic value of the penile pulse and blood pressure: a Doppler study of impotence in diabetics. J Urol 113: 636PubMedGoogle Scholar
  2. 2.
    Aboseif SR, Lue TF (1988) Hemodynamics of penile erection. Urol Clin North Am 15: 1PubMedGoogle Scholar
  3. 3.
    Bahren W, Gall H, Scherb W, Stief C, Thon W (1988) Arterial anatomy and arteriographic diagnosis of arteriogenic impotence. Cardiovasc Intervent Radiol 11: 195PubMedCrossRefGoogle Scholar
  4. 4.
    Benson CB and Vickers MA (1989) Sexual impotence caused by vascular disease: diagnosis with duplex sonography. AJR 153: 1149PubMedGoogle Scholar
  5. 5.
    Bookstein JJ (1990) Letter to the Editor. AJR 286Google Scholar
  6. 6.
    Bookstein JJ, Lange EV (1987) Penile magnification pharmacoarteriography: details of intrapenile arterial anatomy. AJR 148: 883PubMedGoogle Scholar
  7. 7.
    Breza J, Aboseif S, Orvis B, Lue TF, Tanagho EA (1989) Detailed anatomy of penile neurovascular structures: surgical significance. J Urol 141: 437PubMedGoogle Scholar
  8. 8.
    Brindley GS (1983) Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence. Br J Psychiatry 143: 332PubMedCrossRefGoogle Scholar
  9. 9.
    Broderick GA, McGahan JP, Stone AR, deVere White RW (1990) The hemodynamics of vacuum constriction erections: assessment by color Doppler ultrasound. J UrolGoogle Scholar
  10. 10.
    Forsberg L, Olsson AM (1988) Doppler studies of the penile circulation. Urol Radiol 10: 129PubMedCrossRefGoogle Scholar
  11. 11.
    Gall H, Bahren W, Scherb W, Stief C, Thon W (1988) Diagnostic accuracy of Doppler ultrasound technique of the penile arteries in correlation to selective arteriography. Cardiovasc Intervent Radiol 11: 225PubMedCrossRefGoogle Scholar
  12. 12.
    Garibyan H, Lue TF (1990) Anastomotic network between the dorsal and cavernous arteries in the penis. J Urol 143: 221A (Abstract 89)Google Scholar
  13. 13.
    Gaskell P (1971) The importance of penile blood pressure in cases of impotence. Can Med Assoc J 105: 104Google Scholar
  14. 14.
    Goldstein I, Siroky MB, North RI et al (1982) Vasculogenic impotence: role of the pelvic steal test. J Urol 128: 300PubMedGoogle Scholar
  15. 15.
    Krysiewicz S, Mellinger BC (1989) The role of imaging in the diagnostic evaluation of impotence. AJR 153: 1133PubMedGoogle Scholar
  16. 16.
    Lue TF, Hricak H, Marich KW, Tanagho EA (1985) Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology 155: 777PubMedGoogle Scholar
  17. 17.
    Merritt CR (1987) Doppler color flow imaging. J Clin Ultrasound 15: 591PubMedCrossRefGoogle Scholar
  18. 18.
    Michal V, Kramer R, Pospichal J (1978) External iliac “steal syndrome”. J Cardiovasc Surg 19: 355Google Scholar
  19. 19.
    Mueller SC, Lue TF (1988) Evaluation of vasculogenic impotence. Urol Clin North Am 15: 65PubMedGoogle Scholar
  20. 20.
    Paushter, DM (1989) Role of duplex sonography in the evaluation of sexual impotence. AJR 153: 1161PubMedGoogle Scholar
  21. 21.
    Quam JP, King BF, James EM, Brakke DM, Ilstrup DM, Parulkar BG, Hattery RR (1989) Duplex and color Doppler sonographic evaluation of vasculogenic impotence. AJR 153: 1141PubMedGoogle Scholar
  22. 22.
    Robinson LQ, Woodcock JP, Stephenson RP (1989) Duplex scanning in suspected vasculogenic impotence: a worthwhile exercise? Br J Urol 63: 432PubMedCrossRefGoogle Scholar
  23. 23.
    Schwartz AN, Wang KY, Mack LA, Lowe M, Berger RE, Cyr DR, Feldman M (1989) Evaluation of normal erectile function with color Doppler sonography. AJR 153: 1155Google Scholar
  24. 24.
    Schwartz AN, Lowe MA, Ireton R, Berger RE, Richardson MI, Graney DO (1990) A comparison of penile brachial index and angiography: evaluation of corpora cavernosa arterial inflow. J Urol 143: 510PubMedGoogle Scholar
  25. 25.
    Shabisgh R, Fishman IJ, Shottland Y, Karacan I, Dunn JK (1990) Comparison of penile duplex ultrasonography with nocturnal pegile tumescence monitoring for the evaluation of erectile impotence. J Urol 143: 924Google Scholar
  26. 26.
    Tanagho EA, Lue TF, McClure RD (1988) Functional evaluation of penile arteries with papaverine. In: Kist (ed) Contemporary management of impotence and infertility. Williams and Wilkins, Baltimore, chap 5, pp 57–69Google Scholar
  27. 27.
    Virag R (1982) Intracavernous injection of papaverine for erection failure: Letter to the Editor. Lancet 2: 938PubMedCrossRefGoogle Scholar
  28. 28.
    Virag R, Bouilly P, Frydman D (1985) Is impotence an arterial disorder? A study of arterial risk factors in 440 impotent men. Lancet 1: 181PubMedCrossRefGoogle Scholar
  29. 29.
    Virag R, Frydman D, Legman M, Virag H (1984) Intracavernous injection of papaverine as a diagnostic and therapeutic method in erectile failures. Angiology 35: 79PubMedCrossRefGoogle Scholar
  30. 30.
    Wesper E, Delcour C, Rondeux C, Struyven J, Schulman CC (1987) The erectile angle: objective criterion to evaluate the papaverine test in impotence. J Urol 138: 1171Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • G. A. Broderick
  • T. F. Lue

There are no affiliations available

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