Alternative names: Doppler ultrasonography of penile vessels.
It should be clarified that on old devices only duplex scanning was performed (B-mode and Doppler mode were used); in modern scanners, color Doppler mapping is a mandatory option, and doctors try to use it in any case, which is why the method is most often called Doppler ultrasound vessels of the penis.
Dopplerography is the use of the Doppler principle in ultrasound diagnostics: a change in the length of a sound wave when the medium in which it propagates moves relative to the source of sound wave radiation (this is a simplified interpretation of the principle). The diagnostic value of scanning lies in the ability to assess the functional state of blood vessels and their throughput. The data obtained are of great importance in terms of diagnosing erectile dysfunction, which is becoming an increasingly pressing problem every day.
Indications for ultrasound examination of the penis
- lack of erection;
- differential diagnosis of forms of erectile dysfunction;
- identification of organic causes of erectile dysfunction.
Preparing for the study
No special preparation is required for this ultrasound diagnostic method. The patient is recommended to urinate and perform minimal hygienic treatment of the genital area before starting the procedure.
Conducting research
It is better to perform the examination on an expert-class device equipped with a multi-frequency linear sensor with an operating frequency of up to 7 MHz. During the study, 3 modes are used, which is why the method is sometimes called triplex scanning.
Position the patient on his back. The first stage of the examination in B-mode is aimed at studying static indicators of the condition of the tissues of the penis: the echostructure of the tissues of the penis, the symmetry of various sections, the ratio of different types of tissues in the structure of the cavernous bodies are described. Next, a study of blood flow in deep (cavernous) arteries and veins is carried out - the diameter of the vessels, the presence of foreign elements in their lumen (for example, atherosclerotic plaques), and the condition of the vascular wall are assessed. At the final stage, color Doppler mapping is carried out using a pulse mode, which makes it possible to determine the direction of blood flow, as well as a number of other dynamic parameters.
During the examination, the sensor is usually placed at the base of the penis at an angle of 45 degrees.
Nuances of ultrasound examination of the vessels of the penis
This test is relatively non-invasive. Correctly assessing the state of blood flow in the penis is possible only during an erection, for the occurrence of which medications are used that are injected into the cavernous bodies. The study of the vessels of the non-erect penis is not very informative and may be of interest only as a control measurement. The information obtained during the examination of an erect penis has diagnostic value.
Medicines used include papaverine, phentolamine or alprostadil. The study is possible without the administration of these drugs, if the patient can cause an erection through genital stimulation. Pharmacologically stimulated erection can persist for 4 hours; if it persists longer, it is recommended to consult a urologist.
Examination results and their interpretation
The main parameters determined during the examination (normal values are indicated for the erection phase):
- peak systolic velocity in the deep arteries (PSS or PSV) is normally 40-50 cm/s;
- end diastolic velocity (EDV or EDV) – 4-5 cm/s;
- resistance index (RJ), norm – 1.0;
- pulsation index (PI) is normal - 7-13 - a derived indicator reflecting the ratio of the difference between the maximum and minimum flows to the average blood flow speed;
Normal indicators of the above parameters indicate the absence of pathology or the presence of psychogenic erectile dysfunction. Deviations of these parameters indicate the predominance of arterial or venous causes of erectile dysfunction.
Cavernosography and cavernosometry will help increase the information content of ultrasound diagnostics of penile vessels.
Literature:
- Abstract of the dissertation for the scientific degree of Candidate of Medical Sciences “The importance of Doppler ultrasound of the vessels of the penis in the diagnosis and treatment of erectile dysfunction.”
- http://www.ncbi.nlm.nih.gov/pubmed/11505538
- Mazo E.B., Zubarev A.R., Zhukov O.B. “Ultrasound diagnosis of vasculogenic erectile dysfunction”, 2003.
Ultrasound of the penis is an accessible and informative method for diagnosing the male genitourinary system. Its use is effective for identifying pathological abnormalities in organ structures, changes in spongy, cavernous bodies and a number of other problems.Ultrasound of the genital organ often has no alternative. It is safe and can be performed at any age and repeatedly. However, it is rarely used as an independent study; as a rule, it is carried out in combination with Doppler measurements.
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What parameters are being studied?
Ultrasound of the penis evaluates a number of indicators:
- the speed of blood movement through the arteries and veins, characterizing the state of the organ’s vessels;
- diameter and thickness of arterial walls;
- echogenicity of cavernous tissues. Based on these results, it is possible to recognize symptoms of circulatory disorders, fibrosis, inflammation, and the presence of pathological foci;
- thickness and elasticity of the membrane (tunica albuginea) of the penis;
- parameters of venous blood flow. The presence of venous outflow at the time of absolute erection is a sign of erectile dysfunction.
What abnormalities are detected by ultrasound with and without Doppler?
Examination of the penis using ultrasound with a conventional sensor allows you to detect:
- neoplasms of the urethra and penis;
- vascular thrombi;
- pathological changes in the penis;
- the presence of scars and foreign bodies in the urethra;
- calcification of erectile tissue;
- condition of the cavernous and spongy bodies;
- the structure of formations (if any) and the degree of neglect of the process.
Ultrasound of the penis with the Doppler effect allows you to determine:
- disturbances in blood flow rate;
- reasons for early ejaculation;
- vascular tone;
- the condition of the vascular walls, their elasticity and structural changes;
- features of arterial inflow and venous outflow of blood from the organ.
Diseases and pathologies of the penis that a urologist can diagnose
Ultrasound of the penis allows you to detect a wide range of pathologies and make an accurate diagnosis for the patient. These include the following violations:
- Vascular thrombosis is an inflammatory thrombosis of the venous wall, characterized by the formation of blood clots that block the lumen of the vessels. The disease significantly increases the risk of death in men suffering from cardiovascular disease;
- Malignant and benign formations. Provided timely diagnosis and treatment, the prognosis for a benign tumor is favorable. Elimination of a malignant tumor without serious consequences is possible only in 60% of cases, even if it is detected at the initial stage.
- Fibrosis of the corpora cavernosa is a partial or complete replacement of the cavernous bodies of the penis with scar tissue, accompanied by various deformations of the organ (curvature, shortening, narrowing). This pathology disrupts the erectile function of men;
- Atherosclerotic lesions are a dangerous disease characterized by narrowing or complete blockage of the vessels of the penis. May cause decreased libido, chronic impotence, urinary problems and prostate adenoma;
- Stenosis of the penile arteries is a serious pathology in which the lumen of the vessel is closed by more than 70%. Drug treatment in this case is ineffective; blood flow can only be improved through surgical intervention;
- – a pathology characterized by curvature of the penis due to fibroplastic degeneration of its tunica albuginea. The disease is quite rare - in 0.5-1% of men aged 35-60 years;
- Traumatic consequences (cavernitis, abscess, shortening and deformation of the penis, erectile dysfunction, urethral stricture);
- Congenital anomalies of the organ.
Indications
Ultrasound of the penis is a key examination in finding the causes of erectile dysfunction. In addition to impotence, indications for the procedure are:
- injuries of various types;
- penis fracture;
- local swelling;
- curvature of the genital organ, which may indicate Peyronie's disease;
- presence of neoplasms;
- decreased erectile function;
- preparation for surgery or plastic surgery in this area;
- swelling or pain when urinating;
- pain or discomfort during sexual intercourse;
- presence of scars and hematomas;
- suspicion of a foreign body or urethral diverticula;
- suspicion of atherosclerosis of the vessels of the penis, accompanied by a weakening of potency;
- suspicion of the development of cavernous fibrosis;
- – one of the most unpleasant and dangerous diseases for a man is the expansion of the veins located in the testicles;
- monitoring the patient's condition in the postoperative period;
- assessment of treatment effectiveness.
Ultrasound of the penis is also prescribed to patients who refuse to undergo diagnostics of erectile dysfunction using an invasive method.
Preparation
Ultrasound of the penis does not require special preparation. However, certain recommendations should be followed so that the doctor can assess the condition of the organ as accurately as possible and make the correct diagnosis.
Necessary:
- 1-2 days before the examination, stop taking medications for the treatment of erectile dysfunction;
- Carry out thorough hygienic treatment of the intimate area and the penis itself;
- On the day of the study, refrain from masturbation and sexual intercourse;
- In 1-2 days, completely eliminate the consumption of alcoholic beverages.
It is also not advisable to urinate before the examination. If the situation is urgent, it is allowed to visit the toilet 30 minutes before the start of the procedure.
How is the procedure performed?
For a successful ultrasound of the penis, two mandatory factors must be present:
- A diagnostic urologist is a highly qualified specialist who is proficient in ultrasound techniques;
- Availability of modern high-quality equipment.
The duration of the procedure is about 30-60 minutes. The patient is in a supine position. At the doctor's discretion, the man's legs can be straightened or bent at the knees. The penis is placed on the stomach or on a towel folded between the thighs.
Initially, an overview scan is performed in a resting state of the organ: the doctor applies a special gel to the penis to improve contact with the sensor, then runs the sensor over the skin to assess the anatomical structures and initial blood flow.
To determine the deformation of the penis, blood flow and assess the blood supply to the corpora cavernosa, a pharmacological test is performed - the introduction of a vasoactive drug into the penis to create an induced erection. To do this, it is necessary to apply a special elastic tourniquet to the base of the genital organ.
An injection with a special drug (caverject, vasaprostan, etc.) is carried out with a thin needle directly into one of the cavernous bodies under ultrasound control. It is virtually painless and lasts only a few seconds. As a rule, the drug prostaglandin E1 is used, which significantly reduces the threat of priapism - a prolonged painful erection caused artificially (not due to sexual arousal) and does not stop after sexual intercourse.
To fully assess vascular blood flow, color duplex mapping is used. Arteries are assessed in the phase of turgescence (or swelling) and rigidity (erection), veins - in the phase of detumescence (decay of erection).
Features of the procedure
A common problem in men during the procedure is the psychological factor. Injecting the drug into the penis can provoke a fear of pain in a man, as a result of which stress mechanisms are activated and the tone of the nervous system increases. A psychological barrier arises. All this can lead to the development of spasm in the cavernous arteries, due to which the erection will be incomplete or completely absent.
The “lifeline” in such situations is alternative methods of stimulating an erection (taking Levitra or Viagra). Manual (hands) and audiovisual (erotic videos, photos) stimulation can also be used to improve the quality of erection.
The peculiarity of the procedure is the fact of the long-term effect of the drug, which is why the penis can remain in an erect state for a long time. To eliminate this “nuance,” a man is allowed to resort to masturbation. If after this the erection persists for more than 4 hours (priapism), it is necessary to urgently consult a urologist for consultation. In this situation, patients with diabetes are at particularly high risk. Therefore, the patient should warn the doctor in advance if he suffers from this disease.
It is also worth noting that after a pharmacological erection, a second erection should not be allowed earlier than after 4 hours. This is extremely dangerous for erectile function and can lead to its complete loss.
Decoding the results
The ultrasound results are entered by the doctor into a special protocol:
- Echogenicity. If no deviations were found, then the transcript is marked “normal”. Hyperechogenicity indicates cavernous fibrosis, hypoechogenicity indicates inflammation of the cavernous bodies (acute cavernitis).
- Changes in the cavernous bodies. A homogeneous structure is considered the norm. The heterogeneous structure of tissues is a sign of cavernous fibrosis.
- Pathology of the tunica albuginea of the penis. At rest, the thickness of the membrane should be about 2 mm, during erection - 0.5 mm. Exceeding this value may indicate Peyronie's disease. The tunica albuginea should have “normal” echogenicity. Detection of hyperechogenicity is a reason to prescribe additional examinations for vascular damage.
- The normal diameter of the arteries is from 0.2 to 1.4 mm. Exceeding the indicator (more than 1.4 mm) indicates abnormal development of the vessels of the penis. A diameter of less than 0.2 mm indicates the presence of pathologies associated with diabetes, atherosclerosis or other autoimmune diseases.
Indicators of the normal intensity of blood movement during systole:
The normal pulsation index is over 4.
Normal resistance index values:
Blood mobility is determined in the deep dorsal vein. When an erection occurs, there should be no blood flow in it. Otherwise, the possible diagnosis for a man is disappointing - erectile dysfunction.
Contraindications
Ultrasound of the penis is contraindicated if there are:
- open wounds on the penis;
- acute inflammation of the organ;
- sexually transmitted infections and other specific infections that require immediate treatment.
Can there be side effects after the examination?
The procedure is generally safe and painless. However, the patient may experience mild pain during the administration of the drug for induced erection and discomfort if he has been found to have organ damage or an infection in the acute stage.
Also, a small hematoma may occur at the injection site, and sometimes mild dizziness may occur. These symptoms go away quickly. But to avoid such complications, some clinics are more inclined to use alternative methods of stimulating an erection.
What additional procedures may be prescribed?
In some cases, the doctor may prescribe an ultrasound of the scrotum with Doppler ultrasound of the blood vessels. With its help, the condition of the patient’s scrotum and the quality of blood flow in it will be assessed. Like ultrasound of the penis, examination of the scrotum does not require special preparation. The procedure is absolutely painless and non-invasive.
During an ultrasound of the penis, specialists can also examine blood flow, arteries and the intensity of venous outflow. Almost always, the study is carried out in conjunction with Doppler ultrasound. The advantage of the procedure is that it is absolutely painless. During the scan, the patient does not feel any discomfort. In addition, there is no need to prepare for the examination. You can go through it at any time convenient for a man.
The examination allows you to identify diseases at an early stage of development. Therefore, doctors recommend that some men undergo regular ultrasound examinations for preventive purposes. Information obtained from the study helps doctors create an effective treatment program. Ultrasound scanning is also prescribed for patients before penile surgery. In this case, the method helps to correctly plan the course of the surgical intervention.
Price for ultrasound of penile vessels
The cost of research in Moscow varies greatly. The reason for this is that each institution sets its own price for ultrasound. At the same time, they take into account the prestige of the clinic, the training of specialists, the quality and modernity of the equipment used. But if you want to undergo an ultrasound of the vessels of the penis quickly and at a reasonable cost, then just sign up for diagnostics at the Open Clinic.
Examination in Moscow
Ultrasound of the penis in the capital is carried out in specialized diagnostic centers. But you can undergo the examination quickly and without queues at the Open Clinic. The procedure takes on average no more than 20 minutes. The examination is carried out in our institution using modern, new generation devices. We guarantee that with us you will receive high service, medical care from the best doctors in the capital and an individual approach.
Ultrasound of the penis- This is one of the most common studies of the genital organs in men, with various pathologies.
This modern diagnostic method has a number of advantages: it is informative, safe, widely available, and also does not cause any unpleasant or painful sensations.
Besides, Ultrasound of the genital organ can be carried out repeatedly, and in some cases this research method has no alternative.
How is an ultrasound of the genital organ performed in men?
Depending on the purpose of the study, doctors at our clinic conduct:
- Ultrasound of cavernous tissues. This type of diagnosis is most often used for Peyronie's disease, which is a curvature of the genital organ due to the formation of a fibrous plaque or fractures of the genital organ.
- Ultrasound of cavernous tissue can accurately determine the location of plaques in Peyronie’s disease, as well as the presence of calcifications in them. In case of a penile fracture, this type of ultrasound helps to determine the location of the rupture of the tunica albuginea, its condition, the presence of hematomas, as well as their size.
- Ultrasound of the vessels of the penis. This type of study is considered highly informative for identifying erectile dysfunction or impotence associated with vascular pathologies.
During the examination, doctors at our clinic evaluate arterial inflow and venous outflow, identify the stage of vascular blood flow disturbance, and also monitor the dynamics and effectiveness of the treatment.
Ultrasound of the penis in men does not require any preliminary preparation. It can be carried out both in a hospital setting and in a clinic and even at home. The main conditions for successful diagnosis:
A urologist who is proficient in ultrasound diagnostic methods and conducts examinations not just once in a while, but regularly;
Modern ultrasonic equipment of expert class.
In addition, it is worth understanding that Ultrasound of the penis– despite its accessibility and safety, it is considered a complex procedure for the doctor who conducts the diagnosis.
Indications for ultrasound of the genital organ
Closed injuries resulting from bruise, blow or bending of an erect organ;
Open injuries resulting from a fracture, animal bite, impact using piercing or cutting objects;
Tumors of the genital organ;
Infectious diseases accompanied by swelling, hyperemia of the penis, pain during urination, during sexual intercourse, the appearance of a rash, discharge or ulcers;
Peyronie's disease;
Vascular pathologies of the male genital organ.
If you need to go Ultrasound of the genital organ or get advice on this issue, then the doctors of our medical institution are ready to help with this.
We offer each client a huge range of services that help diagnose and then cope with the identified illness.
For this, our clinic has everything necessary: highly qualified specialists, as well as modern and high-tech equipment.
The type of erection a man will have is influenced by the filling of the sexual organ, or rather its cavernous bodies, with blood. If this function is impaired, a Doppler ultrasound examination may be prescribed. This safe diagnosis will help determine the condition of blood vessels and general blood supply. The condition of deep arteries, which cannot be examined by any other method, is also assessed. Determining the cause of failure in erectile function is the main task of ultrasound examination. The method is safe and will not harm the male reproductive system or erection in any way.
Basics of the technique
The method of studying the vessels of the penis is based on the well-known Doppler effect. It consists in the fact that ultrasound waves tend to be reflected from moving blood cells. Depending on their speed, the frequency of the return sound wave will differ. Sent and received signals are analyzed and the results are displayed on the monitor in the graphics villa.
During diagnosis, peak systolic indices of blood flow velocity are measured. During this, the blood flow speed is calculated from zero to peak values per unit of time. If the criterion exceeds 100 m/s, this indicates damage to the vessel.
In addition, the distolic index is fixed. In a state of erection, this indicator should be equal to zero. If blood flow is recorded in this state, this indicates a pathological condition of the blood vessels.
Doppler ultrasound often has to be combined with other vascular examination techniques. For example, duplex scanning. In this case, it is possible to determine not only the narrowing of the arteries, but also the location of this narrowing. If this is observed, then a decrease in erectile function occurs due to vascular damage. This can happen due to chronic diseases such as diabetes or atherosclerosis.
When is it appointed?
In order for the doctor to prescribe a detailed examination of the vessels of the penis, a preliminary examination is necessary. If abnormalities and certain complaints are detected, the man is referred to a Doppler ultrasound procedure. Indications for the implementation of the method are:
- Erection problems.
- Lack of potency.
- Injury to the genital organ.
- New growth on it.
- Prescribed in case of refusal to check the state of erectile function using invasive techniques.
- Before plastic surgery on the genital organ.
This method has a number of contraindications, including:
- Inflammation on the penis.
- Fever.
- Sexually transmitted infections and other specific infections.
What can the procedure determine?
During the study, it is possible to discover the cause of deterioration in blood supply, and therefore the causes of erectile dysfunction.
In addition, the following pathologies can be detected:
- Vascular thrombosis at different stages of development.
- Tumor, malignant and benign.
- Fibrosis of the corpora cavernosa.
- Plaques on blood vessels.
- Arterial stenosis is a narrowing of their lumen, which interferes with normal blood circulation.
- Peyronie's disease.
- Consequences of injuries.
What parameters are being studied?
To carry out diagnostics, a special sensor is used, which is applied to the penis on both sides - this helps to examine all the structures of the organ. During an ultrasound, the following important organ parameters are examined:
- Velocity of venous and vascular blood flow. This indicator will tell you a lot about the blood supply to the organ and its speed.
- Diameter and thickness of artery walls. This can be done due to their surface location.
- Echostructure of the cavernous bodies. This will help determine possible inflammatory processes and their location. A detailed examination will make it possible to see the development of fibrotic pathologies in tissues. Pathological disturbance of blood flow.
- Elasticity of the protein membrane, parameters of its thickness. If thickening is observed, this indicates Peyronie's disease. It leads to curvature of the penis, fibrous changes occur in its tunica albuginea. When checking echogenicity, it is possible to detect the site of development of the pathological process.
- Parameter of blood flow in veins. There should be no venous outflow during the period of arousal; if it exists, this indicates erectile dysfunction.
How is the research conducted?
First of all, blood flow is studied in a calm state. After a detailed study, a special drug is injected into the penis, which provokes an instant erection. In this state, all necessary parameters are also checked.
If for any reason drug stimulation or puncture cannot be done, Viagra is used. This is often known before the procedure, so the patient needs to take the tablet 30 minutes before the test on an empty stomach.
In a state of erection, each phase of its development is examined, blood flow is measured every 5 minutes. The duration of the study does not exceed 40 minutes; upon completion, a protocol is issued.
Some features of the procedure
Many men are frightened not by the diagnostic process itself, but by the need to inject a drug into the penis. This will likely lead to pain at the puncture site. This can become a psychological barrier.
This condition is fraught not only with fears, but also affects the quality of the research. This is because stressful situations are accompanied by an increase in the tone of the nervous system. This leads to spasms of the cavernous arteries, so an erection may not be complete or may not occur at all. And this does not make it possible to obtain complete information.
In such cases, not only Viagra can be used, but also manual and audio and video visualization.
Another difficulty in using injection stimulation is maintaining an erection for a long time. In this case, self-stimulation is needed. If this does not help, and the erection lasts more than 4 hours, you should consult a urologist.
Conclusion. Ultrasound scanning of the penis is a procedure that will help determine the cause of erectile dysfunction. The procedure cannot be called completely painless, since injections are used, but there is an alternative for them.
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