陰莖都普勒超音波對於預測血管再成形術中陰莖供應血流血管狹窄或阻塞之實用性
董聖雍、張奕凱、劉詩彬、謝汝敦、張宏江
臺大醫院 泌尿部
Effectiveness of penile Doppler ultrasound in predicting penile supplying artery stenosis or occlusion under percutaneous transluminal angioplasty
Sheng-Yung Tung, Yi-Kai Chang, Shih-Ping Liu, Ju-Ton Hsieh, Hong-Chiang Chang
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
Purpose: We utilized pelvic angiography, as a golden standard for diagnosing penile arterial insufficiency, to evaluate the accuracy of penile Doppler for diagnosing arterial type erectile dysfunction
Materials and Methods: A total of 541 consecutive patients received penile Doppler exam at our institute between January 2013 and August 2017. Patient demographics and clinical information were extracted from the electronic database of our institute. Total 131 times percutaneous transluminal pelvic angiography and possible angioplasty (PTA) were performed by a single cardiologist for erectile problems during the period. Patients who had received previous pelvic angiography exam were excluded. 98 patients who received further pelvic angiography within six months after penile Doppler exam were enrolled in the study.
Results: Among the 98 patients who received penile Doppler and subsequent first-time pelvic angiography, the median age was 61 years old (range 19-78 years old), median BMI 26.8 kg/m2 (range 17.4-43.4). Poor correlation was found between PSV or RI and penile supplying arterial stenosis under angiography (area under curve 0.399 and 0.449, respectively in ROC curve), but there was noticeable correlation found between CTA findings and penile supplying arterial stenosis under angiography (area under curve 0.748 in ROC curve). Thus, no cut-off value could be defined for diagnosing possible penile supplying artery stenosis with the aid of PSV under penile Doppler.
Conclusion: Findings of penile Doppler had a poor correlation with those of pelvic angiography for patients with erectile dysfunction problems, which implied further angiographic evaluation should be considered for ED patients despite normal penile Doppler findings. CT had good correlation with angiography and could be considered as a non-invasive exam prior to angiography exam. For patients with normal angiography results but poor blood flow pattern under penile Doppler, local treatments as penile low-intensity shock wave therapy (LiST) may be helpful for treating focal tissue ischemia.