The Penile Blood Flow Study: Evaluation of Vasculogenic Impotence by Duplex Ultrasonography
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  and Brindley  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.
KeywordsVasoactive Intestinal Polypeptide Peak Systolic Velocity Tunica Albuginea Corporal Body Emissary Vein
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