Frequency and anatomic distribution of arterial obstructions in patients with vasculogenic erectile dysfunction not responding to intracavernous prostaglandin

Summary: Background: The extent of arterial disease in patients with erectile dysfunction (ED) non-responsive to intracavernosal injection of Alprostadil is of importance for therapeutic options. However, published evidence, in particular angiographically validated is scarce. Here we investigated arterial lesion patterns in this specific patient cohort by selective angiography. Patients and methods: A cohort of 239 patients received a clinical and duplex-sonographic workup for ED of suspected vascular origin. Duplex ultrasound of the cavernosal arteries was performed after intracavernosal injection of 10 μg Alprostadil. Consequently, standardized workup included grading of the erectile and determination of peak systolic velocity (PSV) and end-diastolic velocity (EDV) in both cavernosal arteries. PSV-values below 30 cm/sec indicated reduced arterial flow, whereas EDV-values above 15 cm/sec indicated a venous leak of the pudendal veins. All patients with suspected arterial ED based on duplex sonography underwent contrast-enhanced computed tomography. Endovascular therapy was carried out in ED patients not responsive or with significant side effects to PDE-5-inhibitors or Alprostadil by selective angiographic depiction of erection-related arteries. Results: 54 patients with a mean age of 61.2 (±9.8) years underwent angioplasty of erectionr elated arteries. Out of these 48/54 (89%) patients presented with an erection considered insufficient for penetration (E0-E3) subsequent to intracavernous application of 10 μg Alprostadil. 14/48 (29%) patients had bilateral arterial obstructions and 34/48 (71%) had unilateral disease. Commonly affected was the internal pudendal artery (n = 31, 65%), followed closely by the common penile artery (n = 30, 64%). The least affected arteries were the dorsal penile (n = 6, 13%), hypogastric (n = 4, 8%), common iliac (n = 4, 8%), cavernosal (n = 4, 8%), and inferior gluteal (n = 1, 2%) arteries. Conclusions: Arterial obstructions amenable to endovascular revascularization are frequent in patients non-responsive to intracavernosal prostaglandin administration. Therapeutic strategies in ED patients non-responsive to conservative measures should therefore consider endovascular treatment opportunities.

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Duplex Sonography versus Angiography for Assessment of Femoropopliteal Arterial Disease in a “Real-World” Setting

Journal of Endovascular Therapy ◽

10.1177/152660280701400404 ◽

2007 ◽

Vol 14 (4) ◽

pp. 452-459 ◽

Cited By ~ 25

Author(s):

Oliver Schlager ◽

Marcel Francesconi ◽

Markus Haumer ◽

Petra Dick ◽

Schila Sabeti ◽

...

Keyword(s):

Real World ◽

Predictive Value ◽

Velocity Ratio ◽

Peak Systolic Velocity ◽

Duplex Ultrasound ◽

Weighted Kappa ◽

Arterial Disease ◽

Duplex Sonography ◽

Kappa Statistics ◽

Sensitivity Specificity

Purpose: To evaluate the agreement of duplex ultrasound (DUS) versus digital subtraction angiography (DSA) for assessment of femoropopliteal arterial disease in a real-world clinical setting. Methods: Consecutive patients with peripheral artery disease who were scheduled for a percutaneous intervention were included in this retrospective study. During an 18-month period, 491 patients (276 men; median age 73 years, interquartile range 64–81) were enrolled. A peak systolic velocity ratio (PSVR) >2.4 was the optimal cutoff for detecting a >50% stenosis by DSA. Findings of preprocedural DUS in the proximal, middle, and distal ipsilateral superficial femoral artery and in the popliteal segment were analyzed for agreement with preprocedural femoropopliteal DSA using kappa statistics. Only the target limb in each patient was analyzed, for a total of 1964 vascular segments. Results: Agreement for the degree of stenosis in 10% increments was only moderate (weighted kappa 0.67, 95% CI 0.65 to 0.69). Using the PSVR >2.4 cutoff, agreement between DUS and DSA for a >50% stenosis was good (kappa 0.79, 95% CI 0.77 to 0.81). Sensitivity, specificity, positive predictive value, and negative predictive value for correctly detecting a >50% stenosis by DUS were 0.81 (0.78 to 0.84), 0.93 (0.91 to 0.94), 0.84 (0.81 to 0.87), and 0.91 (0.87 to 0.95), respectively. Comparable findings were observed within different patient subgroups. Conclusion: Agreement between DUS and DSA in the femoropopliteal segment is only moderate with respect to the absolute degree of stenosis. However, detection of a >50% stenosis can be done with acceptable precision in routine clinical practice using PSVR >2.4 as a threshold.

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A systematic review of intracavernosal injection of mesenchymal stem cells for diabetic erectile dysfunction

Medical Journal of Indonesia ◽

10.13181/mji.oa.204475 ◽

2021 ◽

Author(s):

Gampo Alam Irdam ◽

Febriyani ◽

Nur Rasyid ◽

Akmal Taher

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Erectile Dysfunction ◽

Functional Outcome ◽

Animal Studies ◽

Human Study ◽

Peak Systolic Velocity ◽

Human Studies ◽

Intracavernosal Injection ◽

Endothelial Growth Factor

BACKGROUND As current erectile dysfunction (ED) treatments are limited, other treatment such as stem cells should be explored. Hence, this study aimed to review the sources, method of administration, and therapeutic effect of mesenchymal stem cells (MSCs) for diabetic ED treatment. METHODS All relevant articles regarding the use of MSCs for diabetic ED were searched in PubMed and Google Scholar databases from December 15, 2019 to January 1, 2020 published in the past 10 years. The keywords were “mesenchymal stem cells” and “diabetic ED”. The selection and critical appraisal of the studies were discussed. Diabetic ED was evaluated for functional and structural outcome. Functional outcome in animal studies was assessed by intracavernosal pressure/mean arterial pressure (ICP/MAP) ratio, meanwhile the structural outcome was done microscopically. In human study, the assessments were done using international index of erectile function score (IIEF-5) to erection hardness score and penile Doppler ultrasonography. RESULTS There were 10 animal studies and 3 human studies. The studies used MSCs from adipose (n = 6), bone marrow (n = 4), placenta (n = 1), umbilical cord (n = 1), and muscle tissue (n = 1). The MSCs were administrated through intracavernosal injection in all studies. In all animal studies, functional outcome was improved, shown in higher ICP/MAP ratio. Microscopically, there were an increase of cavernosal endothelial cells, vascular endothelial growth factor, nitric oxide synthase, and smooth muscle cells. In human studies, IIEF-5 and erection hardness score were improved. Peak systolic velocity was also higher. CONCLUSIONS MSCs may be a promising therapy for diabetic ED; however, long-term safety concerns still need further investigations.

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Low-intensity shock wave therapy for erectile dysfunction and the influence of disease duration

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2018.4.276 ◽

2019 ◽

Vol 90 (4) ◽

pp. 276-282 ◽

Cited By ~ 2

Author(s):

Pedro Simoes De Oliveira ◽

Tiago Ribeiro De Oliveira ◽

Álvaro Nunes ◽

Francisco Martins ◽

Tomé Lopes

Keyword(s):

Shock Wave ◽

Erectile Dysfunction ◽

Prospective Study ◽

Disease Duration ◽

Peak Systolic Velocity ◽

Shock Wave Therapy ◽

Treatment Results ◽

Open Label ◽

Low Intensity ◽

Diastolic Velocity

Objective: Low-intensity shock-wave treatment (LiSWT) is a therapy for erectile dysfunction (ED) with good results reported in the literature. The aim of this study was to evaluate the results of LiSWT on patients treated for ED and the influence of ED duration in treatment outcomes. Material and methods: We performed an open-label single-arm prospective study of patients treated with LiSWT for ED. Patients were assessed with the IIEF-5 at baseline and at six weeks and three months after LiSWT, and with penile dynamic Doppler ultrasound before treatment and six weeks after. Patients were divided into two groups accordingly to ED evolution time: ≤ 24 months and > 24 months. Results: Twenty-five patients were enrolled, 13 had ED ≤ 24 months and 12 > 24 months. Median baseline IIEF-5 was 14, at 6 weeks post LiSWT was 16 (p < 0.001) and at 3 months post LiSWT was 18 (p < 0.001). Mean baseline peak systolic velocity (PSV) was 29.3 ± 13.0 cm/s, after LiSWT was 35.9 ± 15.2 cm/s (p 0.001). Mean baseline end-diastolic velocity (EDV) was 2.6 ± 4.8 cm/s and after LiSWT was 1.3 ± 4.3 cm/s (p 0.015). No statistical significative difference was identified between the two groups. Conclusions: LiSWT is a safe, harmless and repeatable treatment tool for ED with good outcomes reported. Our results suggest that length of disease duration doesn´t negatively influences treatment results.

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The Effect of Testosterone Replacement Therapy on Penile Hemodynamics in Hypogonadal Men With Erectile Dysfunction, Having Veno-Occlusive Dysfunction

American Journal of Men s Health ◽

10.1177/1557988318754931 ◽

2018 ◽

Vol 12 (3) ◽

pp. 634-638 ◽

Cited By ~ 6

Author(s):

Ozan Efesoy ◽

Selahittin Çayan ◽

Erdem Akbay

Keyword(s):

Erectile Dysfunction ◽

Replacement Therapy ◽

Erectile Function ◽

Peak Systolic Velocity ◽

Resistive Index ◽

Testosterone Replacement ◽

Testosterone Replacement Therapy ◽

Testosterone Levels ◽

Diastolic Velocity ◽

Physiological Serum

Hypogonadism may cause veno-occlusive dysfunction (VOD) by structural and biochemical alterations in the cavernosal tissue. The aim of the study was to investigate the effect of testosterone replacement therapy (TRT) on penile hemodynamics in hypogonadal men with erectile dysfunction and VOD. The study included 32 hypogonadal men with erectile dysfunction, having VOD. All patients underwent penile color Doppler ultrasonography (PCDU) at the beginning and 6 months after the initial evaluation. Erectile function was evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5); hypogonadism was evaluated by testosterone measurement and the Aging Male Symptoms (AMS) scale. All patients received transdermal testosterone 50 mg/day for 6 months. Clinical and radiological findings were compared before and 6 months after the TRT. The mean age was 58.81 ± 4.56 (52–69) years. Mean total testosterone levels were 181.06 ± 39.84 ng/dL and 509.00 ± 105.57 ng/dL before and after the therapy, respectively ( p < .001). While all patients had physiological serum testosterone levels (>320 ng/dL) after the therapy, three cases (9.3%) had no clinical improvement of hypogonadism symptoms. Cavernosal artery peak systolic velocity (PSV) and resistive index (RI) significantly increased, and end diastolic velocity (EDV) significantly decreased after TRT. VOD no longer existed in 21 (65.6%) of the cases. This study demonstrated that TRT may restore penile hemodynamics in hypogonadal men with VOD.

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Duplex ultrasound evaluation of cavernosal peak systolic velocity and waveform acceleration in the penile flaccid state: clinical significance in the assessment of the arterial supply in patients with erectile dysfunction

International Journal of Andrology ◽

10.1046/j.1365-2605.2000.00227.x ◽

2000 ◽

Vol 23 (4) ◽

pp. 199-204 ◽

Cited By ~ 48

Author(s):

Mancini ◽

Bartolini ◽

Maggi ◽

Innocenti ◽

Villari ◽

...

Keyword(s):

Erectile Dysfunction ◽

Clinical Significance ◽

Peak Systolic Velocity ◽

Duplex Ultrasound ◽

Arterial Supply ◽

Ultrasound Evaluation

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Evaluation of penile blood flow including peak systolic velocity, end diastolic velocity and rigidity index: five patients of erectile dysfunction experience in Shin Kong Memorial Hospital in one year

Urological Science ◽

10.1016/j.urols.2015.06.137 ◽

2015 ◽

Vol 26 (2) ◽

pp. S77

Author(s):

Chao Wei Tseng ◽

Thomas I.S. Hwang

Keyword(s):

Blood Flow ◽

Erectile Dysfunction ◽

Peak Systolic Velocity ◽

Memorial Hospital ◽

Diastolic Velocity ◽

Rigidity Index ◽

One Year

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Application of Superb Microvascular Imaging in the Diagnosis of Vascular Erectile Dysfunction

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3771 ◽

2021 ◽

Vol 11 (8) ◽

pp. 2184-2188

Author(s):

Jun Wu ◽

Fan Jiang ◽

Xiaofeng Lan

Keyword(s):

Blood Flow ◽

Erectile Dysfunction ◽

Color Doppler ◽

Peak Systolic Velocity ◽

Hemodynamic Parameters ◽

Color Doppler Flow Imaging ◽

Diastolic Velocity ◽

Superb Microvascular Imaging ◽

The Difference ◽

Microvascular Imaging

To compare the difference between superb microvascular imaging (SMI) and color doppler flow imaging (CDFI) on vascular grading and blood flow display rate of the penile cavernous artery of vascular erectile dysfunction (ED), and to evaluate the length of time to obtain blood flow spectrum. 68 patients with ED were preformed for the examination of SMI and CDFI. The difference between the two techniques on vascular grading and blood flow display rate were compared. Hemodynamic parameters, namely peak systolic velocity (PSV), end diastolic velocity (EDV), and resistant index (RI) and the length of time obtained blood flow spectrum were compared. SMI was more sensitive to assess vascular grading and blood flow display rate than CDFI (P < 0.05). Hemodynamic parameters (PSV, EDV, and RI) measured by SMI and CDFI were well correlated (r = 0.981, P < 0.001; r = 0.879, P < 0.001; r = 0.937, P < 0.001). The duration of time necessary obtained the spectrums of grade 3 and grade 4 blood flow was shorter than that of grade 1 and grade 2, and SMI was comparatively shorter than CDFI (P < 0.05). In conclusion, SMI detected the blood flow of the penile cavernous artery better and maked the examination time shorter than CDFI, which can be considered as a more effective technique to diagnose vascular ED.

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Penile vascular diagnostic categorization using penile duplex Doppler ultrasound: Differences in vascular hemodynamics parameters by differences in anatomic sampling location

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2016.3.183 ◽

2016 ◽

Vol 88 (3) ◽

pp. 183 ◽

Cited By ~ 3

Author(s):

Fabio Pezzoni ◽

Fabrizio Ildefonso Scroppo

Keyword(s):

Doppler Ultrasound ◽

Prostaglandin E1 ◽

Peak Systolic Velocity ◽

Standard Operating Procedure ◽

Double Sampling ◽

Sampling Location ◽

Intracavernosal Injection ◽

Duplex Doppler Ultrasound ◽

Diastolic Velocity ◽

Duplex Doppler

Objectives. In 2013 the International Society for Sexual Medicine(ISSM) published the guidelines regarding the standard operating procedure (SOP) for penile duplex Doppler ultrasound (PDDU). Although ISSM-SOP have given important strides in reducing interobserver variability in PDDU by procedural protocol and parameters these guidelines do not address the anatomic location along the penis at which hemodynamic measurements have to be done. In our opinion a “double sampling” may be interesting to detect the arteriogenic or venogenic nature of the erectile dysfunction (ED). In particular sampling measurements at the “crus” (at the level of the peno-scrotal junction) may be significative for detection of veno-occlusive dysfunction (VOD),whereas an evaluation at “mid penis” (1/2 distance between peno-scrotal junction and coronal sulcus), may be useful to diagnose an arterial insufficiency (AI). Material and Methods. We evalued 90 men, mean age 56.3, affected with ED of medium degree, responder to PDE5-I that urdergone to PDDU and also responder after pharmacologic intracavernosal injection (PII)of prostaglandin E1 20 mcg, with rigid erection and normal maintenance. We moreover evalued 90 men in youthful age (mean 35.2), in absence of vascular risk factors, no responder to PDE5-I that undergone to PDDU by PII at high dosage (bimix: prostaglandin E1 20 mcg, papaverine 20 mg). Results. In the first pool the sampling at “mid penis” resulted significative for arterial insuffciency (AI) in 81% (73), in presence of normal or borderline end diastolic velocity (EDV). Sampling at the “crus” resulted negative for VOD in 90% (81). In the second pool, 66.6% (60) resulted responder with rigid erection and normal maintenance in presence of normal hemodynamic parameters: peak systolic velocity (PSV) and end diastolic velocity (EDV) both at the “crus” and at “mid penis” sampling. 33.4% (30) responded with a semirigid erection and manifested a constant deficit of maintenance; at the “crus”and at “mid penis” the hemodynamic arterial parameters resulted normal. At the “crus” the EDV resulted significantly augmented (VOD index) in 96.6% (29); at “mid penis” augmented EDV was founded in 50% (15). Conclusions. These observational data would be able to confirm the utility of a routinary “double sampling” procedure, at the “crus” and at “md penis”, during PDDU in order to better distinguish between VOD or AI or in any case to be useful to stimulate a future more precise standardization in execution of PDDU examination.

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