Penile Non-imaging And Imaging

Question 1

T/F
A limitation of penile ultrasound is the sensitivity to injectable medication and/or anticoagulant ion therapy that may prevent use of injection components

Answer 1

True

Question 2

With the non-imaging technique we need to obtain velocities bilaterally of which three arteries

*hint: lower extremity arteries

Answer 2

CFA, PTA, DPA

Question 3

With non-imaging, after obtaining velocities of CFA, PTA, DPA; the next step is to?

Answer 3

Calculate an ABI with appropriate cuffs placed on upper arms and ankles

Question 4

What is the average cuff size for penile pressures

Answer 4

2.5 x 12.5 cm

Question 5

For penile Doppler, what is the appropriate probe placement?

Answer 5

Lateral or ventral

Question 6

According to the vasculogenic impotence stats, what is the penile/brachial index range for:
Normal
Marginal
Abnormal

Answer 6

Normal: >/= 0.75
Marginal: 0.65-0.74
Abnormal: < 0.65

Question 7

When performing the penile plethysmographic test, what is obtained

Answer 7

We obtain a waveform only, meaning we cannot hear the pressures.

Similar to finger and toe PPG tracings.

Question 8

If the penile pressures are reduced, what is most suggestive?

Answer 8

Suggests a more proximal arterial disease (ex: aorta-iliac, internal iliac)

Question 9

When using imaging for penile pressures, what is the recommended probe

Answer 9

Multi frequency 7-10 MHz linear array transducer

Question 10

Do we need a consent in order to proceed with the imaging technique of Penile pressure

Answer 10

Yes, we need an informed consent

Question 11

Prior to injection of medication, what measurements must be obtained?

Same measurements are then re-checked 1-2 minutes AFTER injection

Answer 11

Cavernous (cavernosal) arteries are measured in AP diameter as well as the PSV and EDV

Question 12

What is the purpose of the medication that is injected

Answer 12

Injection is done at lateral aspect, prox to shaft of penis to induce erection

Question 13

What other velocity is obtained after the injection?

Answer 13

Dorsal vein flow velocity

Question 14

What is priapism

Answer 14

Sustained erection

Question 15

It is VERY IMPORTANT to contact urologist immediately if…

Answer 15

If erection is maintained for up to 3 ours in order to reverse the priapism

Question 16

With the imaging technique of penile pressures, results are normal when the DIAMETER of cavernous arteries ______ post-injection, with PRE-injection flow to be ____ resistant, and POST-injection flow to be ____ resistant

Answer 16

The diameter should INCREASE
pre-injection has HIGHER resistance
Post-injection has LOWER resistance

Question 17

With imaging technique of penile pressures, the PSV measurements should _____, with a normal range approximately ___cm/sec or higher

Answer 17

PSV measurements should INCREASE with a range of 30cm/sec or higher (EDV also higher)

Question 18

Should the dorsal vein velocities increase? What does an increase suggest?

Answer 18

should NOT increase, this would suggest a venous leak

• *normal = < 3cm/sec
• *abnormal = > 20cm/sec