1Associate Professor, Department of Urology, SN Medical College, Jodhpur, Rajasthan
2Assistant Professor, Department of Urology, SN Medical College, Jodhpur, Rajasthan
3Senior Resident, Department of Urology, AIIMS, Jodhpur, Rajasthan
*Corresponding author: Dr. Pradeep K Sharma, Associate Professor, Department of Urology, SN Medical College, Jodhpur, Rajasthan. Mob: 9468569933, Email: dr.pradeepurology261@gmail.com
Online published on 10 February, 2017.
The introduction of colour doppler sonography of penis has provided a non-invasive means of assessing patients with suspected vasculogenic impotence. So, this study was planned to determine the value of colour duplex doppler sonography of the flaccid penis in diagnosis of the arteriogenic impotence.
Male patients who had a history of erectile dysfunction for at least 6 months duration were examined first in flaccid state and then after injecting papaverine with gray scale and colour doppler sonography using an ultrasound unit with a high frequency wide band 6–13 MHz linear array transducer. The clinical response to intra-cavernosal injection (ICI) was also evaluated. All patients were observed for any complication. Sensitivity, specificity, negative predictive values (NPV) and positive predictive values (PPV) of peak systolic velocity (PSV) in flaccid penis were calculated. A PSV of less than 25 cm/sec after papaverine injection associated with an abnormal clinical response was used as the diagnostic criterion for arterial insufficiency.
The maximum numbers of patients were having PSVs in flaccid state between 10–15 cm/sec and 35–45 cm/sec after ICI in both cavernosal arteries. 24% (12) of patients were having abnormal clinical response and 76% (38) of the patients were having normal clinical response. Statistically significant difference was found in the flaccid state between the mean PSV in the normal group and in abnormal group. (p<0.04) The mean PSV in patients who were having normal clinical responses after ICI of papaverine was 46.37 cm/sec and 17.32 cm/sec in abnormal group. Cut off value of 10cm/sec for lowest normal pre intra-cavernosal PSV was found best with 91.66% sensitivity, 93.40% specificity, 97.26% NPV and 81.59% PPV.
Color doppler sonography should be the first line investigation to determine PSV in flaccid penis as it was found good predictor of clinical response to ICI of a vasodilator drug.
Erectile dysfunction, flaccid penis, colour doppler sonography, papaverine
