The role of Doppler ultrasound in the evaluation of penile haemodynamics – A sonographer’s guide to the documentation of vasculogenic erectile dysfunction

The role of Doppler ultrasound in the evaluation of penile haemodynamics – A sonographer’s guide to the documentation of vasculogenic erectile dysfunction

Reviewer: Emma Jardine | ASA SIG: General

Author: Napier, D

Why the guide was written

This guide aimed to educate sonographers, standardise the performance of penile Doppler ultrasound examinations and emphasise the importance of accurate diagnosis and management of vasculogenic erectile dysfunction (ED).

It provides a comprehensive guide for sonographers addressing this important aspect of men’s health, including describing the patient preparation, anatomy, physiology, interpretation of ultrasound findings and technical skills required to perform a penile Doppler ultrasound examination.

The author notes that there has been a decline in skilled sonographers who are capable of performing these examinations due to the introduction of oral phosphodiesterase inhibitors, which are used as the first-line treatment in the management of ED. These inhibitors are used to regulate blood flow and aid in muscle relaxation.

Due to this decrease in skilled professionals, there is a lack of a standard protocol for performing and interpreting the haemodynamics of penile Doppler ultrasound.

However, it is noted that despite the success of oral pharmacological treatment of ED, ultrasound remains an important assessment tool in postoperative patients, patients who have had pelvic trauma and those who don’t respond to oral phosphodiesterase inhibitors.

Key findings of the guide

The standout feature of the guide was the detailed recommendations provided for the interpretation of ultrasound findings. The guide notes that vasculogenic ED is the most common form of ED, and is primarily caused by disturbances in the arterial inflow and abnormalities in the veno-occlusive mechanism.

The guide serves as an excellent educational resource that describes five characteristic waveform stages of erection observed during penile Doppler ultrasound. These stages reflect the changes in penile blood flow and vascular dynamics as the penis transitions from a flaccid state to full erection and back to detumescence.

The author also describes the key ultrasound criteria for diagnosing vasculogenic ED, including assessment of the cavernosal artery peak systolic velocity, end-diastolic velocity and the resistive index.

Relevance to clinical practice

This guide is highly valuable, offering detailed guidance and recommendations for sonographers performing penile Doppler examinations. It is a thorough guideline that is a valuable resource for both new and experienced sonographers.

The author highlights growing evidence that suggests vasculogenic ED may be an early indicator of systemic vascular disease, which could make penile Doppler ultrasound a valuable tool for predicting future cardiovascular disease, allowing for early intervention and management. The author explains that penile arteries are smaller than the coronary arteries and therefore may show signs of disease earlier. This indicates that ED can precede the onset of more serious cardiovascular events like heart attacks and strokes due to the underlying endothelial dysfunction affecting the inner lining of blood vessels.

Both ED and cardiovascular disease significantly impact the quality of life. Addressing ED can not only improve men’s sexual health but also overall wellbeing and cardiovascular health. Improved accessibility and application of penile Doppler ultrasound could serve as an effective tool to diagnose disease. This guide serves as a significant step towards improving the diagnosis and treatment of vasculogenic ED, leading to enhanced quality of care and better patient outcomes.

Addressing erectile dysfunction can not only improve sexual health but also overall wellbeing and cardiovascular health