Penile Doppler ultrasonography is a high-performing, noninvasive or minimally-invasive imaging modality that allows the depiction of the normal anatomy and macroscopic pathologic changes in real time. Moreover, functional changes in penile blood flow, as seen in erectile dysfunction (ED), can be analyzed using color Doppler ultrasonography (CDUS). This review article describes the normal sonographic anatomy of the penis, the sonographic technique for evaluating ED, the normal phases of erection, and the various causes of ED. Additionally, we describe the interpretation of different parameters and findings on penile CDUS for the diagnosis and classification of ED, priapism, and Peyronie disease.
Classification ; Diagnosis ; Erectile Dysfunction ; Male ; Penile Induration ; Penis ; Priapism ; Ultrasonography ; Ultrasonography, Doppler* ; Ultrasonography, Doppler, Color

Fibrotic lesions occurring in the corpus cavernosum are usually cases of Peyronie's disease that originate from the tunica albuginea, or they are the fibrotic result of inflammatory processes. The lesion involving the corpus cavernosum, but not tunica albuginea is rare. We present here a case of fibrotic nodule arising in the corpus cavernosum with the sonographic and magnetic resonance imaging features. A 38-year-old man complained a small nodular mass in the left corpus cavernosum at the level of penoscrotal junction without abnormal curvature of the organ. We performed ultrasonography and magnetic resonance imaging to determine exactly what the lesion was. The lesion was removed and it was pathologically found to be a localized fibrotic nodule of the corpus cavernosum with some narrow-channeled vascular structures.
Adult ; Fibrosis ; Humans ; Magnetic Resonance Imaging ; Male ; Penile Induration ; Penis ; Ultrasonography

Peyronie's disease is a distressing disorder that pathophysiology and therapeutic subset of this disease are fairly not established. We studied the effectiveness of verapamil for Peyronie's disease which intralesionally injected with lO mg verapamil every 2 weeks for lO injections or more in 12 men among 15 men with Peyronie's disease at Pusan National University Hospital from May 1995 to May 1996. The mean age was 55.7 year-old (range 30-68). One case had failed prior steroid intralesional injection and four cases had failed prior vitamin E oral medication. The mean volume of plaque was approximated with 7.5 MHz high frequency ultrasound at 3.7ml (range 0.1- 8.4). The plaque causes the penile curvature which was discovered by questioning or intracavernosal injection of prostaglandin E1 in 9 cases (64.3%). Penile pain was rapidly resolved in all preexisting lO cases (lOO%). Of cases with the penile curvature on erection, angulation was decreased in 3 cases (33.3%). The penile rigidity on erection was inquired to be improved more or less in 4 cases (44.4%) with desirable sexual performance. Plaque volume and consistency were reduced in 6 cases (50%). We concluded the verapamil intralesional injection is one of the effective nonoperative therapeutic modality for Peyronie's disease because of the beneficial effects including complete pain relief, modest improvements in penile curvature and erectile function, decreased plaque volume and avoidance of disease progression without no adverse reactions.
Alprostadil ; Busan ; Disease Progression ; Humans ; Injections, Intralesional* ; Male ; Penile Induration* ; Ultrasonography ; Verapamil* ; Vitamin E ; Vitamins

To assess the penile hemodynamic function and penile anatomy, duplex ultrasonography combined with intracavernous papaverine injection was undertaken in psychogenic, neurogenic and vasculogenic impotence patients, and patients with priapism and Peyronie's disease Patients. The results were as follows ; 1. In 7 neurogenic and 7 psychogenic impotence patients, changes of luminal diameter of cavernous artery and peak flow velocity were 0.69 +/- 0.13mm, 8.99 +/- 2.54cm/sec in flaccid phase, and 1.13 +/- 0.12mm, 21.38 +/- 8.43cm/sec in erection phase. 2. In 4 vasculogenic impotence patients, changes of luminal diameter and peak flow velocity were minimal. 3. Penile ultrasound is considered valuable in the evaluation of extent of Peyronie's plaque and determination of the type of priapism. Penile duplex ultrasonography combined with papaverine injection is considered the best screening method of vasculogenic impotence, and valuable in the evaluation of the penile structures.
Arteries ; Erectile Dysfunction ; Female ; Hemodynamics ; Humans ; Impotence, Vasculogenic ; Male ; Mass Screening ; Papaverine* ; Penile Induration ; Phenobarbital ; Priapism ; Ultrasonography*

ObjectiveTo analyze the MRI manifestations of Peyronie's disease and investigate the value of high-field MRI in the diagnosis of the disease.

METHODSUsing a small surface coil, we performed 3.0 Tesla MRI for 14 patients with clinically diagnosed Peyronie's disease. The MRI protocol included routine sequences (T1WI, T2WI, and enhanced T1WI) and susceptibility-weighted imaging (SWI). Each patient had received 2－4 penile ultrasound examinations previously. We compared the MRI findings with the results of ultrasonography.

RESULTSMRI manifested 25 penile plaques in the 14 patients, 3 (7 plaques) with inflammation, 4 (8 plaques) with fibrosis, and the other 7 (10 plaques) with calcification displaying a low signal intensity on SWI. Ultrasonography had revealed the 10 calcified plaques in all the 20 examinations, but exhibited the 7 inflammatory and 8 fibrotic ones in only 3 of the 23 examinations. The combination of MRI SWI sequences was necessitated for the detection of calcified plaques and achieved higher detection rates than ultrasonography for inflammatory and fibrotic plaques (P<0.05).

CONCLUSIONSHigh-field MRI has high sensitivity and accuracy in the diagnosis of Peyronie's disease, which can effectively display penile plaques of different nature in the early stage through multi-parametric sequences.

Calcinosis ; diagnostic imaging ; Fibrosis ; Humans ; Magnetic Resonance Imaging ; instrumentation ; methods ; Male ; Penile Induration ; diagnostic imaging ; Penis ; diagnostic imaging ; pathology ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism. MATERIALS AND METHODS: This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention. RESULTS: Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases. CONCLUSIONS: The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects.
Alprostadil/adverse effects/diagnostic use ; Drug Evaluation/methods ; Humans ; Male ; Middle Aged ; Penile Erection ; Penile Induration/*ultrasonography ; Phenylephrine/*therapeutic use ; Pilot Projects ; Priapism/chemically induced/*prevention & control ; Retrospective Studies ; Ultrasonography, Doppler, Duplex/adverse effects/methods ; Vasoconstrictor Agents/*therapeutic use ; Vasodilator Agents/adverse effects/diagnostic use

AIMErectile dysfunction may be observed in up to 80% of patients with Peyronie's disease. An objective evaluation of the erectile function is attempted to work out in patients with Peyronie's disease.

METHODSPenile deformity, sexual function and penile vascular status were analyzed in 123 patients with Peyronie's disease, who had not received any pertinent treatment.

RESULTSPenile deformity, palpable plaque and pain on erection were seen in 112 (91%), 97 (78.8%) and 27 (21.9%) of the 123 patients, respectively. Of the 76 patients evaluated by color Doppler ultrasounography, veno-occlusive dysfunction as the vascular component for erectile dysfunction was found in 17 (22.3%), arterial insufficiency in 10 (13.1%) and a mixed picture in 23 (30.2%).

CONCLUSIONThe documentation of penile erectile function and the determination of the vascular status using color Doppler ultrasonography can guide the appropriate therapeutic choice.

Adult ; Aged ; Antioxidants ; therapeutic use ; Colchicine ; therapeutic use ; Erectile Dysfunction ; diagnostic imaging ; drug therapy ; physiopathology ; Gout Suppressants ; therapeutic use ; Humans ; Male ; Middle Aged ; Penile Induration ; diagnostic imaging ; drug therapy ; physiopathology ; Penis ; blood supply ; pathology ; physiopathology ; Ultrasonography, Doppler, Color ; Vitamin E ; therapeutic use