Urology/A question about penile doppler ultrasound
I have a question regarding the penile doppler ultrasound, please.
(Please excuse me because I'm not very fluent in English)
Is it ok for the patient to stimulate his penis by hands after the injection and before performing the ultrasound? or can this result in false/inaccurate readings?
The doctor left my brother alone for a few minutes after the injection. My brother found no response to the injection so he decided to use his hands to help induce an erection.
He did not tell the doctor about what he did and the doppler readings were perfect except that the doctor evaluated the erectile response as being (E2).
My brother insists he is suffering severe erectile dysfunction despite the normal results revealed by the ultrasound. So I'm wondering if it is possible that the readings were "false normal" just because of the manual stimulation.
Thanks in advance.
Ali, a penile Doppler ultrasound is done in men with erectile dysfunction (ED) to determine if the blood flow through the arteries (cavernosal arteries) supplying the erectile bodies (corpora cavernosa) is normal. It can also determine if there is a "venous leak". Usually the test is done by the induction of an erection with the intracorporeal injection for a vason-dilating agent (such as papaverine or prostaglandin E1) or more recently by the instillation into the urethra of prostaglandin E2.
These agent do not always produce an erection and sometimes manual stimulation of the penis is necessary to induce the erectile state. Regardless of how the erection is achieved, it does not alter the results of this test. Therefore, this is not a false normal.
I don't know if you or your brother have ever read the information I have written on ED so I will attach it now to give you a broader understanding of the problem and possible causes.
ED: There are many causes for erectile dysfunction (ED). The most common diseases associated with this disorder are vascular conditions (ie atherosclerosis – “hardening of the arteries” and abnormal varicose veins inside the penis - so called "venous leak") and diabetes. Some others include hormone imbalances, neurologic pathology, local penile diseases (ie Peyronie’s disease), smoking, obesity, alcoholism, prostatitis, prostate surgery, certain medications, "recreational drugs", trauma to pelvic nerves or vasculature and chronic perineal pressure from overly aggressive bike or horse back riding. A variety of emotional disturbances (most commonly depression or performance anxiety) can also cause or be a significant factor in those suffering from ED. Very commonly, the etiology is multifactoral. As a result, consultation with a urologist skilled in the evaluation and treatment of ED is recommended.
In addition to a history and physical examination, specialized tests may be indicated to find a cause. Some of the commonly ordered studies include routine blood tests, hormone levels, and penile duplex color ultrasound.
If a correctable cause is found, specific treatment is instituted. If the condition is irreversible, most men today can still be restored to normal functionality with the numerous treatments available including oral medications in the class of PDE5 inhibitors (ie Viagra, Levitra, Cialis & Stendra), vacuum erection devices (VEDs), confidence rings (for those with a pure venous leakage), penile injections (ie Edex, Caverject), urethral suppositories (Muse) and penile prosthetic surgery. PDE5 inhibitors (in proper dosage which varies with the individual) have shown success in about 80% of patients. Side effects may include headaches, flushing, heart- burn, nasal congestion, visual disturbances, dizziness, etc. These drugs are contraindicated in patients with coronary artery disease who take nitrates (ie nitroglycerine) as some deaths have occurred in this group. There is also the potential for a severe drop in blood pressure if PDE5 inhibitors are used in patients who take alpha- blockers (ie Hytrin, Cardura, etc.) or are hypertensive. It is now a recommendation that not more than 25 mgm of Viagra be used within 4 hours of taking an alpha blocker Several other types of medication may alter the blood level of PDE5 inhibitors possibly leading to significant side effects. Other contraindications include certain types of liver and visual disorders (ie retinitis pigmentosa). PDE5 inhibitors have been noted to cause abnormal liver function tests in some otherwise normal men. Because of this, although PDE5 inhibitors are well tolerated by most, they should only be taken with caution and under the supervision of a physician. All 3 of the PDE5 inhibitors available in the USA have about the same success rate. If one fails to respond to the initial dose, it should be increased until either tolerance or the desired effect is obtained.
The way one takes the PDE5 inhibitors may significantly affect their action. The following should guide you in their administration. One should initially start with the lower dose.
Cialis is available in 2 forms: daily use and long acting. The former comes in 2.5 and 5 mgm. doses while the latter is available in doses of 5,10 & 20 mgm. They can be taken without regard to meals. The onset of action is 30-60 minutes for the daily dose and 30 minutes to 4 hours for the long acting form. Cialis for daily use lasts 4 hours while the beneficial effect of the long acting form lasts 18-36 hours.
Viagra is available in doses of 25, 50 & 100 mgm. Levitra comes in 2.5, 5, 10 & 20 mgms doses. Both medications have an onset of action in 30-60 minutes and last about 4 hours. They are typically taken 1 hour before planned sexual intercourse. The absorption of these 2 medications can be adversely affected by diet, especially a diet high in fat. Therefore, it is best to take these an hour or 2 after meals.
Stendra was approved by the FDA in April of 2012. It comes in doses of 50, 100 and 200 mgms. It has a rapid onset in the 15-30 minute range and lasts 3-6 hours. It is not effected by dietary intake. Although the potential exists to lower the blood pressure too much in men taking nitrates, the risker is lower than with the other drugs in this class.
About 60% of patients who fail to respond to maximum doses of one of the PDE5 inhibitors, respond favorably to another and, in the absence of side effects, this is worth trying. Good luck.