Advertisement

Penile Ultrasound

  • Soroush Rais-Bahrami
  • Bruce R. Gilbert
Chapter

Abstract

Penile ultrasound is commonly used in the diagnostic workup of patients with erectile dysfunction (ED), but also plays an important role by providing an anatomic and functional assessment in a multitude of other conditions including Peyronie’s disease, priapism, penile fracture, penile urethral strictures, urethral stones, or diverticulae, or masses involving deep tissues of the penis. As a component of the evaluation for ED, penile Doppler ultrasound (PDU) is performed to assess the quality of arterial blood flow and sufficiency of veno-occlusive mechanisms, both necessary for adequate erections. More recently, PDU is playing a central role in the early detection of otherwise silent coronary artery disease (CAD) in men presented with ED as their initial symptom. PDU is also an essential component of the assessment of external genitalia in trauma situations. Penile ultrasound provides a readily available, minimally invasive diagnostic modality that evaluates both the structural anatomy and functional hemodynamics.

Keywords

Urologic imaging Ultrasonography Sonogram Doppler flow Cavernosal artery Erectile dysfunction Priapism Genital trauma Urethral stricture disease 

References

  1. 1.
    Doubilet PM, et al. The penis. Semin Ultrasound CT MR. 1991;12(2):157–75.PubMedGoogle Scholar
  2. 2.
  3. 3.
    Shin D, Pregenzer G Jr, Gardin JM. Erectile dysfunction: a disease marker for cardiovascular disease. Cardiol Rev. 2011;19(1):5–11.CrossRefPubMedGoogle Scholar
  4. 4.
    Tomada N, et al. Are all metabolic syndrome components responsible for penile hemodynamics impairment in patients with erectile dysfunction? The role of body fat mass assessment. J Sex Med.Google Scholar
  5. 5.
    Corona G, et al. Male sexuality and cardiovascular risk. A cohort study in patients with erectile dysfunction. J Sex Med. 2010;7(5):1918–27.CrossRefPubMedGoogle Scholar
  6. 6.
    Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75.PubMedGoogle Scholar
  7. 7.
    Hayashi T, et al. Lifestyle intervention, behavioral changes, and improvement in cardiovascular risk profiles in the California WISEWOMAN project. J Womens Health (Larchmt). 2010;19(6):1129–38.CrossRefGoogle Scholar
  8. 8.
    Miner MM Erectile dysfunction: a harbinger or consequence: does its detection lead to a “Window of Curability?” J Androl.Google Scholar
  9. 9.
    Inman BA, et al. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009;84(2):108–13.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Billups KL, et al. Erectile dysfunction as a harbinger for increased cardiometabolic risk. Int J Impot Res. 2008;20(3):236–42.CrossRefPubMedGoogle Scholar
  11. 11.
    Patel U, Lees WR. Penile sonography. In: Solibiati L, Rizzatto G, Editors. Ultrasound of superficial structures. London: Churchill Livingstone; 1995. pp. 229–42.Google Scholar
  12. 12.
    Wilkins CJ, Sriprasad S, Sidhu PS. Colour Doppler ultrasound of the penis. Clin Radiol. 2003;58(7):514–23.CrossRefPubMedGoogle Scholar
  13. 13.
    Kim SH, et al. Doppler sonography of deep cavernosal artery of the penis: variation of peak systolic velocity according to sampling location. J Ultrasound Med. 1994;13(8):591–4.PubMedGoogle Scholar
  14. 14.
    Roy C, et al. Duplex Doppler sonography of the flaccid penis: potential role in the evaluation of impotence. J Clin Ultrasound. 2000;28(6):290–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Mancini M, et al. 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. Int J Androl. 2000;23(4):199–204.CrossRefPubMedGoogle Scholar
  16. 16.
    van Ahlen H, et al. Pharmacokinetics of vasoactive substances administered into the human corpus cavernosum. J Urol. 1994;151(5):1227–30.PubMedGoogle Scholar
  17. 17.
    Patel U, et al. Colour flow and spectral Doppler imaging after papaverine-induced penile erection in 220 impotent men: study of temporal patterns and the importance of repeated sampling, velocity asymmetry and vascular anomalies. Clin Radiol. 1993;48(1):18–24.CrossRefPubMedGoogle Scholar
  18. 18.
    Broderick GA, Lue TF. The penile blood flow study: evaluation of vasculogenic impotence. In: Jonas U, Thon WF, Stief CG, Editors. Erectile dysfunction. Berlin: Springer; 1991.Google Scholar
  19. 19.
    Shabsigh R, et al. Comparison of penile duplex ultrasonography with nocturnal penile tumescence monitoring for the evaluation of erectile impotence. J Urol. 1990;143(5):924–7.PubMedGoogle Scholar
  20. 20.
    Benson CB, Vickers MA. Sexual impotence caused by vascular disease: diagnosis with duplex sonography. AJR Am J Roentgenol. 1989;153(6):1149–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Lue TF, et al. Vasculogenic impotence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology. 1985;155(3):777–81.CrossRefPubMedGoogle Scholar
  22. 22.
    Mueller SC, Lue TF. Evaluation of vasculogenic impotence. Urol Clin North Am. 1988;15(1):65–76.PubMedGoogle Scholar
  23. 23.
    Pescatori ES, et al. A positive intracavernous injection test implies normal veno-occlusive but not necessarily normal arterial function: a hemodynamic study. J Urol. 1994;151(5):1209–16.PubMedGoogle Scholar
  24. 24.
    Benson CB, Aruny JE, Vickers MA Jr. Correlation of duplex sonography with arteriography in patients with erectile dysfunction. AJR Am J Roentgenol. 1993;160(1):71–3.CrossRefPubMedGoogle Scholar
  25. 25.
    Bassiouny HS, Levine LA. Penile duplex sonography in the diagnosis of venogenic impotence. J Vasc Surg. 1991;13(1):75–82. (discussion 82–3)CrossRefPubMedGoogle Scholar
  26. 26.
    Quam JP, et al. Duplex and color Doppler sonographic evaluation of vasculogenic impotence. AJR Am J Roentgenol. 1989;153(6):1141–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Naroda T, et al. Clinical studies for venogenic impotence with color Doppler ultrasonography-evaluation of resistance index of the cavernous artery. Nippon Hinyokika Gakkai Zasshi. 1996;87(11):1231–5.PubMedGoogle Scholar
  28. 28.
    Cormio L, et al. Resistance index as a prognostic factor for prolonged erection after penile dynamic colour Doppler ultrasonography. Eur Urol. 1998;33(1):94–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Feldman HA, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med. 2000;30(4):328–38.CrossRefPubMedGoogle Scholar
  30. 30.
    Blumentals WA, et al. Should erectile dysfunction be considered as a marker for acute myocardial infarction? Results from a retrospective cohort study. Int J Impot Res. 2004;16(4):350–3.CrossRefPubMedGoogle Scholar
  31. 31.
    Sullivan ME, et al. Nitric oxide and penile erection: is erectile dysfunction another manifestation of vascular disease? Cardiovasc Res. 1999;43(3):658–65.CrossRefPubMedGoogle Scholar
  32. 32.
    Solomon H, Man JW, Jackson G. Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart. 2003;89(3):251–3.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Montorsi P, Montorsi F, Schulman CC. Is erectile dysfunction the “tip of the iceberg” of a systemic vascular disorder? Eur Urol. 2003;44(3):352–4.CrossRefPubMedGoogle Scholar
  34. 34.
    Guay AT. The emerging link between hypogonadism and metabolic syndrome. J Androl. 2009;30(4):370–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Traish AM, Guay AT Are androgens critical for penile erections in humans? Examining the clinical and preclinical evidence. J Sex Med. 2006;3(3):382–404. (discussion 404–7)CrossRefPubMedGoogle Scholar
  36. 36.
    Lue TF, Tanagho EA. Physiology of erection and pharmacological management of impotence. J Urol. 1987;137(5):829–36.PubMedGoogle Scholar
  37. 37.
    O’Kane PD, Jackson G. Erectile dysfunction: is there silent obstructive coronary artery disease? Int J Clin Pract. 2001;55(3):219–20.PubMedGoogle Scholar
  38. 38.
    Mulhall J, Teloken P, Barnas J. Vasculogenic erectile dysfunction is a predictor of abnormal stress echocardiography. J Sex Med. 2009;6(3):820–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Zambon JP, et al. Cardiovascular and metabolic syndrome risk among men with and without erectile dysfunction: case-control study. Sao Paulo Med J. 2010;128(3):137–40.CrossRefPubMedGoogle Scholar
  40. 40.
    Mottillo S, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56(14):1113–32.CrossRefPubMedGoogle Scholar
  41. 41.
    Bohm M, et al. Erectile dysfunction predicts cardiovascular events in high-risk patients receiving telmisartan, ramipril, or both: the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease (ONTARGET/TRANSCEND) Trials. Circulation. 121(12):1439–46.Google Scholar
  42. 42.
    Batty GD, et al. Erectile dysfunction and later cardiovascular disease in men with type 2 diabetes: prospective cohort study based on the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation) trial. J Am Coll Cardiol. 2010;56(23):1908–13.CrossRefPubMedCentralPubMedGoogle Scholar
  43. 43.
    Kang BC, et al. Post-traumatic arterial priapism: colour Doppler examination and superselective arterial embolization. Clin Radiol. 1998;53(11):830–4.CrossRefPubMedGoogle Scholar
  44. 44.
    Asgari MA, et al. Penile fractures: evaluation, therapeutic approaches and long-term results. J Urol. 1996;155(1):148–9.CrossRefPubMedGoogle Scholar
  45. 45.
    El-Bahnasawy MS, Gomha MA. Penile fractures: the successful outcome of immediate surgical intervention. Int J Impot Res. 2000;12(5):273–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Atan A, et al. Idiopathic penile mondors’ disease: a case report. Int Urol Nephrol. 2002;34(1):97–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Dicuio M, et al. Doppler ultrasonography in a young patient with penile Mondor’s disease. Arch Ital Urol Androl. 2005;77(1):58–9.PubMedGoogle Scholar
  48. 48.
    Sasso F, et al. Penile Mondors’ disease: an underestimated pathology. Br J Urol. 1996;77(5):729–32.CrossRefPubMedGoogle Scholar
  49. 49.
    Nachmann MM, et al. Sickle cell episode manifesting as superficial thrombophlebitis of the penis. J Am Osteopath Assoc. 2003;103(2):102–4.PubMedGoogle Scholar
  50. 50.
    Luzzi GA, Pattinson J, Wathen CG. Penile Mondor’s disease and inherited thrombophilia. Int J STD AIDS. 2006;17(1):70–1.CrossRefPubMedGoogle Scholar
  51. 51.
    Brock G, et al. The anatomy of the tunica albuginea in the normal penis and Peyronie’s disease. J Urol. 1997;157(1):276–81.CrossRefPubMedGoogle Scholar
  52. 52.
    Chou YH, et al. High-resolution real-time ultrasound in Peyronie’s disease. J Ultrasound Med. 1987;6(2):67–70.PubMedGoogle Scholar
  53. 53.
    Kadioglu A, et al. Color Doppler ultrasound assessment of penile vascular system in men with Peyronie’s disease. Int J Impot Res. 2000;12(5):263–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Richards G, Goldenberg E, Pek H, Gilbert BR. Penile sonoelastography for the localization of a non-palpable, non-sonographically visualized lesion in a patient with penile curvature from peyronie’s disease. J Sex Med. 2013;11:5.Google Scholar
  55. 55.
    Horenblas S, et al. Ultrasound in squamous cell carcinoma of the penis; a useful addition to clinical staging? A comparison of ultrasound with histopathology. Urology. 1994;43(5):702–7.CrossRefPubMedGoogle Scholar
  56. 56.
    Lont AP, et al. A comparison of physical examination and imaging in determining the extent of primary penile carcinoma. BJU Int. 2003;91(6):493–5.CrossRefPubMedGoogle Scholar
  57. 57.
    Lan SK, et al. Penile metastasis secondary to nasal NK/T-cell lymphoma. Urology. 2008;72(5):1014–5.CrossRefPubMedGoogle Scholar
  58. 58.
    Gallentine ML, Morey AF. Imaging of the male urethra for stricture disease. Urol Clin North Am. 2002;29(2):361–72.CrossRefPubMedGoogle Scholar
  59. 59.
    Morey AF, McAninch JW. Role of preoperative sonourethrography in bulbar urethral reconstruction. J Urol. 1997;158(4):1376–9.CrossRefPubMedGoogle Scholar
  60. 60.
    Choudhary S, et al. A comparison of sonourethrography and retrograde urethrography in evaluation of anterior urethral strictures. Clin Radiol. 2004;59(8):736–42.CrossRefPubMedGoogle Scholar
  61. 61.
    Morey AF, McAninch JW. Sonographic staging of anterior urethral strictures. J Urol. 2000;163(4):1070–5.CrossRefPubMedGoogle Scholar
  62. 62.
    Kim B, Kawashima A, LeRoy AJ. Imaging of the male urethra. Semin Ultrasound CT MR. 2007;28(4):258–73.CrossRefPubMedGoogle Scholar
  63. 63.
    Bearcroft PW, Berman LH. Sonography in the evaluation of the male anterior urethra. Clin Radiol. 1994;49(9):621–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.The Arthur Smith Institute for UrologyHofstra North Shore-Long Island Jewish Health SystemNew Hyde ParkUSA
  2. 2.Department of UrologyUniversity of Alabama at BirminghamBirminghamUSA

Personalised recommendations