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Adv. Vas. Son.
Test 4 Penile Doppler
| Question | Answer |
|---|---|
| Impotence Etiology: | CV disease, Side effects of meds/surgery (ex. prostatectomy), Drug or alcohol abuse, Psychogenic/stress/depression, Neurogenic dysfunction, Hormonal imbalance, Arterial insufficiency, Venous "leak" |
| Penile perfusion: Pelvis: | Common iliac artery, Internal iliac artery (hypogastric), Internal Pudenal artery |
| Penile perfusion: Penis: | Cavernosal artery (feed main erectile tissue), Bulbourethral Artery, Dorsal artery |
| Erectile tissue anatomy: | Corpora cavernosa x2-Dorsal, Corpus spongiosum x1-Ventral (urethra), Corpora w/ multiple sinusoidal cavities lined w/ smooth muscoe |
| Impotence testing: Non-duplex methods: | Obtain ABI (r/o PAD), Obtain penile systolic pressure (Doppler PPG), Calculate penile/brachial indices, Obtain PVR or PPG WFs |
| Impotence testing: Non-duplex methods: Cont: | Penile systolic pressure- apply appropriate penile cuff @ base of peen (Typically 2.5 x 9 cm or 2.5 x 12,5 cm), Using CW Doppler & gel (Obtain dorsal A flow just PROX to glans), Inflate cuff, Deflate until return signal = penile sys pressure |
| Repeat test for what? | Accuracy |
| Penile/Brachial index: | Divide penile pressure by the higher of the 2 brachial pressure |
| NORMAL Penile/Brachial index: | 0.7-1.0 |
| BORDERLINE ABNORMAL Penile/Brachial index: | 0.6-0.7 |
| ABNORMAL penile/Brachial index: | < 0.6 |
| Penile PVR: | Using penile cuff- inflate to 60 mmHg, Record several PVRs |
| Penile PPG: | Photoplethysmography (PPG)- Obtains distal blood pressure, Sensor placed on glans, Record several WFs, Similar to PVRs |
| Impotence eval: Duplex methods- Flaccid state: | Position peen in cephalad direction, Scan w/ 7.5-12 MHz TD on ventral side, Long & TRV views of entire peen (R/O Peyronie's disease or other abnormalities) |
| Peyronie's Disease: | Scar tissue along length of peen from chronic inflammation of tunica albuginea (causes peen to bend from groath of fibrous plaques in the soft tissue), Painful erections or difficulty achieving/maintaining |
| Impotence eval: Duplex methods- flaccid state- Cont: | Locate both cavernousal As PROX, May measure diameter (challenge b/c they are 0.5mm, normally), Record spectra from each cavernosal artery prox, Meaaure PSV & EDV |
| Penile color duplex exam: | PT or MD inject vasodilatory agent, Tourniquet band places @ base of peen (left in place for 2 mins, then removed), Obtain psectra from PROX cavernousal As @ 5, 10, 15, & 20 mins post injection |
| PRE is what resistance? | HIGH |
| 5, 10, & 15 mins is what resistance? | Erecting time is LOW |
| 20 mins is what resistance? | Erected state is HIGH |
| Vasodilatory agents: Intracavernosal injection (potent vasodilators): | Papavarine (60 mg in 2-5 mL), Prostaglandin E-1, Priaprisn: Erection lasting >3-4 hrs, Possible side effect, Can cause tissue damage if untreated |
| Penile Color Duplex Exam: Duplex methods: NORMAL: | PSV> 3.5 cm/s, EDV <5 cm/s, 75% increase in artery diameter |
| Penile Color Duplex Exam: Duplex methods: ABNORMAL: | EDV > 6 cm/s= venous leak suspected, PSV < 25 cm/sec (insufficient arterial inflow), <75% increase in vessel diameter |
| Duplex method- Post injection: | ↑ in systolic & diastolic flow, When erect, ↓ in diastolic velocity, Retro-diastolic flow is common in normal eval, Normal erectile response should occur w/in 10 mins & be maintained for 30 mins |
| Flaccid state: HIGH RES: | Corporal arterioles are vasoconstricted, Sinus cavity smooth muscles are contracted, Pre-cavernousal A-V shunting, Minimal blood flow into cavernosa |
| Erecting: LOW RES: | 1.Psycho-erotic stimulation- hormone release, 2.Parastmpathetic stimulation causes corpora arterile vasodilation, 3.Relaxation of smooth muscle in sinusoid cavities |
| Erected: HIGH RES: | 4.↑ed flow into sinusoid cavities, 5.Extrinsic compression of outflow Vs by distended cavernosa, 6.Erection & rigidity-maintained by ↑ed inflow/↓ed outflow |
| ABNORMAL study: post papavarine injection: | Insufficient veno-occlusive mechanism results in "venous leak" ( a MAJOR cause of impotence), If abnormal diastolic vels, band can be placed to restrict outflow (If vel ↓es & erection improves- confirms venous leak) |
| Treatment options: | Viagra or Cialis, Injections @ base of organ (ex papavarine), Testosterone replacement, Penile pumps/tension rings, Penile implants |
| Viagra/ Cialis facts: | Not immediate erection, must have desire/stimulation, Must hace cardiac workup as meds may cause a sudden drop in pressure, Priapism possible side effect |
Created by:
EmilyGriffin
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