Ultrasound of the penis. Preparing for an ultrasound of the penis. Ultrasound Dopplerography of the vessels of the penis: indications, methodology How the study is carried out

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 the 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.

Ultrasound of the penis– a diagnostic procedure that visualizes the internal structures of the male genital organ: spongy and cavernous bodies, tunica albuginea, vessels. The results are informative for erectile dysfunction, Peyronie's disease, tumors, hematomas and organ inflammation. Ultrasound of the penis is performed independently and in combination with ultrasound of blood vessels, with or without provocation of an erection. The cost of the technique is determined by the imaging mode, the availability of a pharmacotest, and the type of drug.

Preparation

Advance preparation for an ultrasound of the penis is not necessary. Before the procedure, it is necessary to perform daily hygienic care of the genitals.

What does it show

Basic ultrasound of the penis - two-dimensional gray scale echography (B-mode), displaying the structure of the cavernous and spongy bodies, the lining of the organ. Allows detection of fibrosis, tumors and injuries. Can be performed in combination with ultrasound, duplex and triplex scanning of blood vessels. Duplex study provides information about the size of veins and arteries, their capacity, and the direction of blood flow. Triplex scanning produces a color image that determines the speed of blood flow. A pharmacological test is used to obtain data on blood flow during an erection.

There are standard indicators for the structures of the penis and blood vessels: the echogenicity of the cavernous and spongy body is uniform, moderate, the diameter of the cavernous artery is 0.6-1.0 mm, the peak systolic velocity is 35 cm/sec, the end-diastolic velocity is 0-5 cm/sec . The following groups of pathologies are diagnosed using ultrasound:

Erectile dysfunction. With arteriogenic impotence, blood flow through the cavernous arteries is assessed. The diagnosis can be confirmed by a decrease in speed characteristics - peak systolic velocity less than 25 cm/sec.
Vascular pathologies. Doppler ultrasound reveals abnormalities in vascular development, vein thrombosis, and atherosclerotic plaques. There is an expansion or narrowing of the lumen of blood vessels, changes in vascular architecture, uneven blood flow, and increased echogenicity of the vascular walls.
Acute cavernite. Inflammation of tissues - cavernitis - is provoked by local and general infections (urethritis, sepsis), damage to the urethra. The ultrasound image shows decreased echogenicity and increased blood flow.
Cavernous fibrosis. Pathological compaction of the cavernous bodies, or cavernous fibrosis, is formed due to chronic inflammatory processes, injuries, and priapism. Ultrasound signs of the disease are increased echogenicity, deformation of organ structures. With focal damage, heterogeneity of erectile tissue is determined.
Neoplasms. Benign and malignant tumors, metastases are diagnosed as foci of altered echogenic density.
Peyronie's disease. As Peyronie's disease progresses, the tunica albuginea thickens. Structural deformations, plaques and compactions can be detected - areas of increased echogenicity.

Ultrasound of the genital organs is prescribed as part of a comprehensive diagnosis of andrological diseases. Scan results are not used in isolation to make a diagnosis, but are interpreted in conjunction with physical examination, clinical interview, and laboratory tests.

Advantages

Examination of the male external genitalia using ultrasound is a safe diagnostic technique. The procedure is completely painless, has no effect on health, and can be used repeatedly without any risks. Penile ultrasound is affordable compared to other imaging tests, such as MRI. Carrying out an intracavernosal test as part of echography of the penile vessels increases the cost of the study - it can vary slightly depending on the drug used. The disadvantage is the low resolution of ultrasound images and the inability to differentiate certain types of tumors.

Full erection of the penis depends on the degree of filling of its cavernous bodies with blood. Erectile dysfunction becomes a reason for prescribing and performing Doppler ultrasound.

Using this diagnostic technique, the circulatory system of the penis is examined and the condition of the superficial and deep arteries is assessed. An indicator such as the intensity of blood circulation in these large arteries makes it possible to determine the causes of erectile dysfunction.

Indications for Doppler sonography

Ultrasound examination techniques are widely used in medical diagnostics. It is absolutely safe, informative, and can be repeated an unlimited number of times. The ultrasound procedure is generally available according to the price category.

Complaints that necessitate an ultrasound of the penis:

erectile dysfunction;
lack of potency;
possible injuries;
voluminous neoplasms.

Ultrasound examination of the penis is prescribed to patients who refuse to undergo diagnostics of sexual dysfunction using invasive techniques. Contraindications to Dopplerography of the penis are elevated body temperature, inflammatory process in the tissues of the organ, and specific infections.

Most often, ultrasound diagnostics allows you to determine:

development of vascular thrombosis;
tumor formation process;
fibrosis of the corpora cavernosa;
atherosclerotic lesions;
stenosis of the arteries of the genital organ;
Peyronie's disease;
traumatic consequences.

Parameters examined by ultrasound

To carry out the procedure, a special sensor is used: the superposition of sound waves on each other forms a complete image of all organ structures. During an ultrasound scan of the penis, the following physiological and anatomical characteristics are necessarily assessed:

The speed of blood flow in vessels and veins. This indicator indicates the state of the circulatory system of the penis.
Diameter and thickness of artery walls. This becomes possible due to their surface location.
Echogenicity of the structure of the cavernous bodies. This characteristic makes it possible to determine the localization of possible foci of inflammation, the development of fibrous changes in organ tissues, and pathological circulatory disorders.
The level of elasticity of the tunica albuginea (membrane) of the penis and its thickness.
Indicators of blood flow in the veins. If, at the moment of absolute arousal, venous outflow is noted, this may indicate erectile problems.

Ultrasound of the penis is often combined with Doppler ultrasound of blood vessels or duplex scanning technique. If ultrasound scan readings indicate a narrowing of the lumen of the arteries, and the movement of blood flow is insufficient, then potency disorders may be of a vascular nature. Most often, pathological narrowing of blood vessels is a consequence of a chronic disease, perhaps atherosclerosis or diabetes.

Thickening of the membrane of the penis is a sign of Peyronie's disease, which is characterized by curvature of the penis and the development of fibrous changes in the tunica albuginea. The echogenicity indicator makes it possible to visualize the localization of the pathological process.

Doppler scanning technique

Dopplerography is based on the Doppler effect. It consists in the frequency changes of ultrasonic waves during the reflection of their moving substances. When the directional beam of a sound wave and a moving blood cell are in relative coincidence, a frequency change in the ultrasonic signal occurs. Using this data, the particle speed is calculated. These indicators are coded, graphically generated, and changes in circulatory velocity are presented visually.

During vascular diagnostics, peak systolic blood flow rates are examined. The dependence of the rate of increase in blood flow from zero to peak and over time is calculated. The criterion is above 100 m/s. indicates damage to the blood vessels of the examined organ.

Indicators of diastolic changes in blood flow are also recorded. In a state of full erection, the blood flow rate should be zero. Registration of blood flow in the veins of the penis in a rigid state indicates vascular pathologies.

Dopplerography allows you to identify the condition of the penile vessel and record the characteristics of blood flow. This data can help in diagnosing the disease and preparing a treatment plan.

Carrying out the Doppler ultrasound procedure

The quality of blood flow is studied in a state of rest and arousal of the penis. In the second case, pharmacodopplerography is used, where an injection of a drug into the cavernous bodies is used, causing a spontaneous erection.

In cases where injection of the drug is impossible and threatens the development of complications, Viagra is used to stimulate erectile function. The drug must be taken on an empty stomach half an hour before the examination. The use of Viagra is often combined with psychological factors that cause sexual arousal.

The procedure begins with examination of the penis in a non-excited state. Then scanning is carried out in all phases of erectile arousal. Interpretation of the examination results is done instantly, immediately after the procedure. Doppler ultrasound lasts no more than 40 minutes. From the moment an erection occurs, the intensity of blood flow is recorded every 5 minutes.

Also, duplex scanning allows you to find out the causes and etiology of circulatory disorders in the pelvic organs. The procedure is widely used in urology and andrology. The results of Dopplerography of the vessels of the penis facilitate diagnosis and make it possible to prescribe effective therapy.

Detection of a weakening of arterial blood flow through the vessels indicates the development of arteriogenic erectile dysfunction. A symptom of this pathology is a prolonged and incomplete erection. Disturbances in venous blood flow contribute to the rapid but short-lived erection. Ultrasound scanning of the penis is performed to diagnose developmental disorders, neoplasms, possible injuries in men, as well as to identify the causes and pathologies that cause erectile dysfunction during a general examination before plastic surgery.

Along with conducting a standard ultrasound examination of the organs of the male reproductive system, Dopplerography of the vessels of the penis is also performed. The main objective of this technique is to determine the speed and direction of blood flow, its volume, assess the lumen of blood vessels and exclude the presence of blood clots, aneurysms, and developmental abnormalities that impede normal blood circulation. This study is a supplement.

Since in more than 50% of cases, erectile dysfunction in men is of vascular origin, ultrasound dopplerography (ultrasound examination combined with Dopplerography) of the penile vessels is considered the most accessible, accurate and harmless diagnostic method.

The essence of the method and indications

A physicist of Austrian origin, Christian Doppler, proved that the frequency and wavelength of radiation directly depends on the nature and speed of movement of the object under study. This phenomenon was named, which formed the basis for such an examination as Dopplerography of blood vessels.

An ultrasound machine equipped with a Doppler may have the following modes:

Color Doppler, or color Doppler, maps blood flow velocities based on colors (often blue and red).
ED, or power doppler. In this mode, the assessment of the blood flow pattern in the vessels occurs due to the intensity and brightness of the color shades of the reflected signals.
ID – pulsed wave Doppler assesses the spectrum of blood flow velocities using acoustic signals.

Indications for performing ultrasound scanning of the vessels of the scrotum and penis:

Erectile dysfunction, that is, the inability to achieve an erection or maintain it sufficiently to achieve ejaculation.
Injury to the genital organ (hematoma, dislocation, fracture or bruise).
To detect foreign objects in the lumen of the urethra.
Confirmation of Peyronie's disease, which is characterized by the formation of dense elastic fibrous plaques on the inner lining of the vessels of the penis.
Varicocele (varicose transformation of the venous vessels of the spermatic cord).
Neoplasms in the scrotum and genital organ of various nature.
Altered urination in men due to structural pathologies of the urethra.
Pain and swelling of the scrotal tissue.

Dopplerography of blood vessels can be an addition. The diagnosis will reliably see the condition of the scrotum and evaluate the size, degree of maturity, and the nature of the blood supply.

Methodology of preparation and conduct

In order for Doppler ultrasound of the penis to give clear and reliable results, the patient must:

Three days before the examination, avoid drinking alcoholic beverages, especially beer.
Three hours before the ultrasound, limit fluid intake and urinate half an hour before the ultrasound.
Before the procedure itself, careful hygiene of the genital organs should be carried out.

For adequate visualization of the vessels, the male genital organ must be in an erect state, which requires the introduction of vasodilator drugs (Papaverine, Phentolamine, prostaglandin E1 or Alprostadil) into the cavity of the corpora cavernosa. This scanning of blood vessels after the use of drugs is called pharmacodopplerography.

If the patient categorically refuses this preparation procedure, then he can be offered to perform local anesthesia with Lidocaine before the injection itself, or take one tablet of Cialis or Viagra (being phosphodiesterase inhibitors, these drugs cause an erection).

Ultrasound scanning of the penis is performed immediately after achieving an erection. To do this, the patient is placed on the couch in a supine position and a sensor lubricated with gel is placed on the base of the penis at an angle of 45°. The doctor evaluates the anatomical structures, takes the necessary measurements and then, using color Doppler mapping, conducts a study of linear and volumetric blood flow velocity and the resistance index.

If there are indications, it may be necessary.

What is assessed and decoding

When performing an ultrasound of the tissues and vessels of the penis, the diagnostician analyzes the following structures and indicators:

The number, localization and echostructure of the cavernous and sponginous bodies. The two cavernous bodies are represented by hypoechoic round structures with a diameter of 3-5 mm, surrounded by a hyperechoic layer - the tunica albuginea (no more than 5 mm). Between them and somewhat downward there is the sponginous body - a round formation that has greater echogenicity than the cavernous body due to the passage of the urethra through it (on ultrasound it looks like a line). The normal echostructure of these formations is homogeneous, without inclusions.
At the initial stage of erection, the maximum systolic speed is about 35 cm/s or more, and the diastolic speed is 8 cm/s or more. For young patients with sufficient erection, these indicators can normally reach 100 and 18-20 cm/s, respectively. The diameter of the cavernous bodies also increases to 6-10 mm.
During the erection rigidity phase, systolic and diastolic blood flow rates decrease. In this case, the peak systolic velocity should be at least 25-30 cm/s, if it was not possible to achieve it, then this indicates erectile dysfunction of arterial origin.
The increase in the cavernous bodies from rest to the moment of erection should not exceed 60%, and the difference between the peak systolic velocity on the right and left should not exceed 10 cm/s. Diastolic current in the rigidity phase should be less than 5 cm/s, and ideally 0.
Normally, the resistance index is more than 0.85, and the pulsation index is more than 4.
The length and thickness of the walls of arterial vessels, the diameter of the lumen and the presence of atherosclerotic plaques and blood clots (in the form of hyperechoic formations protruding into the lumen, while the speed of blood flow in their area slows down) are also assessed.
Direction of blood movement. On the CDC, the blood flow towards the sensor (artery) is colored red, and the blood flow away from the sensor (vein) is colored blue.

Using Doppler ultrasound, it is possible to detect disturbances in blood flow velocity, detect narrowing of the lumen of a vessel due to obstruction or stricture, and record cavernous-fibrous transformation of the vascular wall and its injury.

Preparation

Advance preparation for an ultrasound of the penis is not necessary. Before the procedure, it is necessary to perform daily hygienic care of the genitals.

What does it show

Erectile dysfunction. With arteriogenic impotence, blood flow through the cavernous arteries is assessed. The diagnosis can be confirmed by a decrease in speed characteristics - peak systolic velocity less than 25 cm/sec.
Vascular pathologies. Doppler ultrasound reveals abnormalities in vascular development, vein thrombosis, and atherosclerotic plaques. There is an expansion or narrowing of the lumen of blood vessels, changes in vascular architecture, uneven blood flow, and increased echogenicity of the vascular walls.
Acute cavernite. Inflammation of tissues - cavernitis - is provoked by local and general infections (urethritis, sepsis), damage to the urethra. The ultrasound image shows decreased echogenicity and increased blood flow.
Cavernous fibrosis. Pathological compaction of the cavernous bodies, or cavernous fibrosis, is formed due to chronic inflammatory processes, injuries, and priapism. Ultrasound signs of the disease are increased echogenicity, deformation of organ structures. With focal damage, heterogeneity of erectile tissue is determined.
Neoplasms. Benign and malignant tumors, metastases are diagnosed as foci of altered echogenic density.
Peyronie's disease. As Peyronie's disease progresses, the tunica albuginea thickens. Structural deformations, plaques and compactions can be detected - areas of increased echogenicity.