Ultrasound of the corpora cavernosa. Ultrasound of the penis

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 Doppler 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, you must perform daily hygiene care behind the genitals.

What does it show

Basic ultrasound of the penis is a 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. In case of 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 common infections(urethritis, sepsis), damage to the urethra. The ultrasound image shows reduced echogenicity and increased blood flow.
• Cavernous fibrosis. Pathological compaction of the cavernous bodies, or cavernous fibrosis, is formed due to chronic inflammatory processes, injuries, 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. Deformations of structures, plaques and compactions can be detected - foci of increased echogenicity.

Ultrasound of the genital organs is prescribed as part of complex diagnostics 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 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 price 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.

The ultrasound method is a real-time display of the internal state of the human body using high-frequency sound waves.

Ultrasound diagnoses problems with internal organs, blood vessels, soft tissue structures in the body. Although this method is usually associated with examinations during pregnancy, ultrasound is used to diagnose many other parts of the body, including gallbladder, kidneys, liver, pancreas, stomach, bladder and many other internal structures.

Ultrasound of the penis is the most informative method diagnostics of male genitourinary system. Ultrasound examination is widely available, has no contraindications and no harmful consequences for human health, as it uses sound waves rather than radiation.

What are the indications for this study?

This type of research is also one of the most highly informative and safe and plays important role in establishing the causes of impotence. Erectile dysfunction in more than half of cases is caused by disturbances in vascular blood flow. Doppler ultrasound (USDG) makes it possible to see the condition of the vessels of the genital organ, arterial inflow and the consistency of veno-occlusion mechanisms, on which the quality of erection directly depends.

In addition to the study of erectile dysfunction, ultrasound is also used in anatomical and functional assessment for many other ailments, in particular with injuries and neoplasms, infectious diseases, curvature of the penis, priapism, stones, foreign bodies, strictures and diverticula of the urethra.

An ultrasound of the penis may be ordered by surgeons during a procedure such as a biopsy. They play an important role in planning certain types therapy and surgery, as well as postoperative period to determine whether the patient's body is responding to treatment. Ultrasound can be used to detect cysts, blockages, or infections in the body.

Thus, ultrasound is performed in such cases as:

• Injuries, closed damage, penis fractures
• Open injuries caused by an animal bite, careless handling of piercing or cutting objects
• Penile vascular pathologies
• Peyronie's disease
• Swelling and pain during urination or sexual intercourse caused by infection
• Erectile dysfunction in men
• Congenital anomalies in the development of the penis

What preparation is required before the procedure?

Dopplerography of the penis does not require special preparation, so bladder fullness and diet do not matter. Doctors do not recommend taking medications to treat erectile dysfunction one or two days before the test, and you may be asked to refrain from masturbation and sexual intercourse on the day of the test in order to achieve the most accurate results during the test.

How is Doppler ultrasound of the penis performed?

The procedure takes on average about 30 minutes. It is non-invasive and relatively easy to perform, but requires the participation of a qualified and well-trained specialist. The ultrasound machine must be equipped with color and pulse Doppler, modern high-frequency sensors.

For performing ultrasound examination the penis must be in an excited state. For this purpose, the patient is offered special medications that can cause an erection. If a pharmacologically satisfactory erection cannot be achieved, the patient may be asked to retire for self-stimulation. By the end of the study, the erection usually goes well.

However, there is a possibility that it will be painful and excessively long, which can lead to serious complications and may require the administration of an antagonist drug. In such a situation, especially high risk patients suffering from diabetes mellitus. Therefore, if you are in this group of patients, you should notify your doctor about your illness in advance.

The following are also possible side effects, such as pain and hematoma at the injection site, slight dizziness. In some clinics, to avoid complications, patients are asked to take a pill of an erection-promoting drug in advance of the study and are provided with visual stimulation.

Carrying out the research procedure

At the discretion of the doctor, during the examination the patient lies on his back with his knees straightened or bent and half bent. hip joints legs, the genital organ is placed on the stomach or on a towel folded between the thighs. At the first stage, a survey study is performed - gray scale echography. To do this, the doctor applies a special acoustic gel to the penis and, moving the sensor directly over the skin, evaluates the anatomical structures and the initial, “resting” blood flow.

Then a pharmacological erection is performed. The drug is injected with a thin needle directly into one of the corpora cavernosa under ultrasound control; the injection itself is minimally painful and lasts only a few seconds. Preference is given to prostaglandin E1 preparations due to their slower and longer action with less risk of causing priapism. A complete assessment of vascular blood flow is available using color duplex mapping during the phase of turgescence (or swelling) and rigidity (i.e. directly during erection). The arteries are assessed, and the veins are visualized during the detumescence phase (decay of erection).

What does the doctor see during the examination?

The penis consists of a pair of corpora cavernosa and a corpus spongiosum located below and between them. Cavernous, or cavernous, bodies appear on the screen of an ultrasound machine in the form of homogeneous hypoechoic (gray) round structures surrounded by thin light, i.e. hyperechoic layer, the so-called tunica albuginea. Spongy, or spongy, body, also round in shape and in in good condition has a homogeneous structure, often relatively greater echogenicity, the urethra passes through it, looking like a line.

The doctor documents the results by taking three photographs at the base and in the middle of the penis, and at the level of the head in such a way that the right cavernous body appears to the left, and the left, on the contrary, with right side picture. Depending on which surface of the penis was scanned, upper or lower (dorsal or ventral, as the doctor will most likely designate them), the corpus spongiosum with the urethra passing through it will respectively appear below or above the cavernous bodies.

How is the patient's condition assessed?

If the doctor does not detect any abnormalities in the echogenicity of the structures, he will describe it in the protocol as “normal” or “usual.” Increased echogenicity of the cavernous bodies may be due to the presence fibrotic changes, and a decrease in echogenicity is due to swelling due to their inflammation. The tunica albuginea is normally of uniform thickness, no more than 0.2 cm at rest and about 0.05 cm during erection. In the case of Peyronie's disease, the membrane unevenly, often along the dorsal (upper) side, thickens in the form of hyperechoic plaques, in the structure of which calcium is often deposited, which on ultrasound gives an intense echo with a “track”, the so-called acoustic shadow.

Ultrasound results of the penis. Arrows mark the sites of rupture of the tunica albuginea as a result of trauma.

At rest, the diameter of the cavernous arteries is assessed (normally 0.3-0.5 cm), the maximum systolic blood flow velocity is usually 15-25 cm/s, diastolic flow is minimal or absent. After the injection, measurements are taken every five minutes and changes in the blood flow of the vessels corresponding to the phases of erection are noted.

At the beginning of an erection, the maximum systolic velocity normally reaches 35 cm/s and higher, and diastolic current is recorded at a speed of 8 cm/s. In young patients with normal erections, these values ​​can reach 100 and 20 cm/s, respectively. The diameter of the cavernous arteries increases to 0.6-1.0 cm, the pressure in them increases, the diastolic current decreases and during the rigidity phase it levels out and becomes reversible. If the study fails to obtain a peak systolic velocity of 25 cm/s, this indicates an arterial origin of the dysfunction.

Borderline values ​​are considered to be 25-30 cm/s. Other important markers are an increase in the cavernous arteries by less than 60%, the difference between peak systolic velocities on the left and right is more than 10 cm/s, the time of increase in velocity to peak is 100 m/s or more in atherosclerotic lesions. If a diastolic current of 5 cm/s or higher is recorded during the rigidity phase, we can talk about venous insufficiency.

Since one of the mechanisms for maintaining an erection is compression of the veins by the blood-filled cavernous bodies, it will not be possible to reliably assess the venous flow in case of arterial dysfunction.

Can there be side effects after the procedure?

In general, the procedure is safe and painless. However, the patient may experience painful sensations and discomfort if diagnosed with damage or infection of the genital organ.

After an ultrasound, the erection goes away quite quickly. But in 1-2% of cases, a persistent, continuous erection is possible - priapism. This is potentially dangerous as the penis will not have access to the required amount of oxygen or will not be able to get rid of the accumulated urine during this time. If the patient still has an erection three hours after the injection, it is necessary to contact the attending urologist.

What other procedures can the doctor prescribe?

In addition to ultrasound of the penis, a ultrasound examination scrotum with Doppler ultrasound of blood vessels. It will help assess the condition of the patient’s scrotum, the quality of blood flow in it, and also identify possible deviations from the norm. Examination of the scrotal organs also does not require special preparation. The procedure is non-invasive and painless.

When will the survey results be ready?

The result of the examination is available almost immediately. After the procedure, the doctor will show you the finished images and explain their meaning.

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 scan 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 is a 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. In case of 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. Deformations of structures, plaques and compactions can be detected - foci 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.

Ultrasound of the penis is a diagnostic procedure that allows you to obtain information about the condition of the male genitalia and the presence of pathologies or diseases.

The study is publicly available and absolutely safe, often has no alternative, and can be administered many times without harm to health.

Such ultrasound diagnostics It is almost never prescribed as an independent procedure; in most cases, ultrasound is complemented by Doppler ultrasound.

Visual examination makes it possible to determine the degree of changes in the spongy and cavernous bodies, as well as in the membranes of the penis, and in the vessels that feed it. Ultrasound is extremely necessary in the following cases:

• For injuries, curvatures and fractures of the organ;
• With decreased libido and problems with erection;
• To confirm Peyronie's disease;
• To identify congenital anomalies developments or formations that have recently appeared on the penis;
• If the patient is planning surgery on this organ in the near future.

What makes it possible to detect an ultrasound scan of the penis?

Ultrasound of the vessels of the genital organ – necessary examination, which makes it possible to detect a wide range of pathologies and diagnose the patient correct diagnosis. This will be the key to timely and adequate therapy.

A urologist can prescribe an ultrasound scan if a man initial examination complained of loss of erectile function, curvature of the organ, voluminous tumor-like neoplasms, injuries or previous STDs.

If necessary, an acoustic study can be repeated many times, and in some cases only this technique will detect anomalies in the structure of organ tissue.

This is highly informative diagnostic method, and gives the urologist the opportunity to identify pathologies:

• Arterial inflow;
• Venous outflow;
• Blood flow speed;
• Vascular blood flow disorders;
• Vascular tone;
• Early lesions of the walls of blood vessels;
• Elasticity of vascular walls;
• Structural changes in vascular walls.

But in order for the examination results to be reliable, the ultrasound examination of the penile vessels should be performed only by a qualified specialist who can establish the correct clinical picture disease and prescribe further examinations or treatment. Only in this case can a man count on resuming a full sexual life.

Ultrasound of the penis is recommended to be carried out on a regular basis, which will help not to miss initial stage diseases. In addition, if the patient is prescribed treatment, it must be completed in full, taking into account all the recommendations of the urologist.

How to do an ultrasound of the penis, preparation for the procedure

Ultrasound of the penis with Doppler ultrasound is performed using ultrasound scanner, which has additional color mapping functions.

The method itself is based on the acoustic properties of ultrasound and its ability to give a clear picture of blood vessels after it is reflected from moving blood cells.

Mapping allows us to identify different colors intensity of blood flow in various vessels. Typically, Dopplerography of the penis is performed after a conventional ultrasound, and the same equipment is used for these purposes.

Doppler ultrasound is necessary to determine the rate of blood flow through the arteries that supply the penis with blood, to identify the characteristics of these arteries and the intensity of outflow venous blood.

The procedure does not require any special preparation from the man. No special diet or full bladder is needed. All manipulations can be carried out at any convenient time.

The patient is placed on his back, the diagnostician applies a hypoallergenic gel-like composition to the organ so that the scanner comes into closer contact with skin. The sensor is moved over the skin, after which the necessary tissues are completely visualized on the screen. The equipment allows you to record Doppler spectra of arteries located deep inside the organ.

The patient receives a printout with the results of the examination immediately after its completion.

Features of the procedure

If necessary, they resort to pharmacological erection - in this way the degree of filling of the cavernous bodies, blood flow through the arteries and signs of deformation of the penis are determined.

A plastic tourniquet is installed at the base of the organ, and a certain medication, for example, Vazoprostan, is injected into one of the cavernous bodies in the appropriate dose.

The drug is absorbed into other cavernous bodies and the penis becomes erect. In this condition, he is again subjected to ultrasound examination and Doppler mapping. Then the specialist leaves the office, and the patient has the opportunity to remove pharmacological effect using self-stimulation.

A man may experience subjective sensations of discomfort in the penis area caused by an injection of a stimulant drug. Because of this, the erection may be partial.

If such a situation arises, and it is not possible to postpone the procedure, then the patient must independently, with the help of stimulation, achieve the state of a fully erect organ. Naturally, the specialist leaves the manipulation room at this time.

After completing all the manipulations, the man is warned that maintaining an erection for more than 4 hours is very dangerous and irreversible loss of erectile abilities may occur. If you cannot get rid of an erection, you need an immediate consultation with a urologist and andrologist.

Interpretation of ultrasound results. Normal indicators, possible pathologies.

All results obtained are interpreted by a specialist according to generally accepted protocol.

The first point is echogenicity. If the patient has no deviations in this parameter, then the transcript will be marked “normal”.

Increased echogenicity indicates cavernous fibrosis. Decreased - indicates the presence of inflammation inside the cavernous bodies, this is acute cavernitis.

The second is structural changes in the cavernous bodies. IN healthy condition their structure must be homogeneous. If there is no homogeneity, then focal cavernous fibrosis can be assumed.

The third characteristic is pathology of the organ’s tunica albuginea. The thickness of this tissue when the organ is not erect should not exceed 2 mm, and during an erection the maximum normal value is 0.5 mm.

If this figure is increased, then the man is suspected of having Peyronie's disease. The tunica albuginea also has its own acceptable echogenicity values: if normal, the transcript will say “normal.” If the norm is exceeded, hyperechogenicity occurs.

The echogenicity of the wall in the cavernous artery - if everything is good, the doctor will mark it as “normal”, and if it increases, the patient will be prescribed additional examinations to exclude the possibility of developing atherosclerotic or diabetic vascular damage.

Indicators of the diameter of the cavernous arteries. They should be in the range from 0.2 to 1.4 mm. An expanded lumen is characteristic of abnormally developed vessels, and a narrowed lumen is characteristic of pathologies caused by atherosclerosis, diabetes or autoimmune diseases.

General assessment of the procedure for ultrasound examination of the penis: maximum blood flow velocity in the arteries of the cavernous bodies at the time of systole with calm state organ - 15-25 cm/s, when the caverns are filled with blood -35 cm/s, with a persistent erection - less than at the beginning of filling.

If the indicators do not correspond to the given standards, the patient is suspected of arterial insufficiency. During systole, the highest resistance of arterial vessels is noted.

The final intensity of blood flow through the arteries at the time of diastole is 0 cm/s in a quiet position, and 10 cm/s or more at the time of erection.

The normal pulsation index is greater than 4.

The resistance index is normally noted at 0.8 in the absence of an erection, and at the beginning it should decrease to 0.7 or less, with a full erection - 1.0.

The speed of blood flow inside the deep dorsal venous vessel is determined. With a stable erection provoked by a drug injection, the outflow should completely stop. If this does not happen, then the man may be diagnosed with erectile dysfunction.

All of the above represents ultrasound of the penis as an important diagnostic method in the male genital area. The procedure does not require special preparatory measures, but has its own characteristics and nuances. In general, the examination is completely safe, does not take much time and gives comprehensive results.

Using this procedure, the properties of blood flow in the penis and scrotum are determined. Dopplerography of the vessels of the penis uses ultrasound to determine whether the patient has vascular erectile dysfunction (impotence).

This method is in addition to the ultrasound procedure and has its advantages:

• absolute safety;
• the diagnosis is established with 100% accuracy.

The operating principle is based on the Doppler effect - sound wave the length changes with the movement of the medium in which it is located. Next, the computer determines the frequency of the signal and carries out the necessary mathematical processing.

With the help of Doppler, it is possible to: assess the condition of the blood vessels, whether there are any pathologies of the penis and scrotum, and also determine the capacity of the vessels.

Often, for a complete analysis, blood flow is measured during an erection, it is induced using an injection or films and magazines with erotic content. This addition to conventional ultrasound is called pharmacodopplerography.

Indications for the study:

The procedure is also indicated for examining the scrotum. Indications:

USPDG will help in determining:

• vascular tone in the genitals;
• reasons for the rapid release of seminal fluid during intercourse;
• is the blood flow rate impaired?
• violations of the elasticity of the walls of blood vessels;
• malignant tumor.

The study is prescribed and conducted by a urologist. Special training Dopplerography is not required, but several rules must be followed:

How does the research process work?

The patient is in a supine position. The doctor must induce an erection in the subject by injecting prostaglandin or papaverine E1, then 10 minutes later, an examination is performed using a high-frequency linear sensor, the cavernous arteries are shown on the computer screen and the device calculates the speed of blood flow through them. In addition, the scrotum is examined. A non-erect penis will provide little information, only a control measurement.

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After the procedure, an erection may not occur, then the patient will need to perform self-stimulation of the penis until seminal fluid is released, at which time the diagnostician will leave the office. If the agitation does not subside after 5 hours, it is necessary to consult a urologist.

The results are deciphered as follows:

Evaluated characteristics:

• an indicator of the thickness of the tunica albuginea of ​​the penis, as well as the level of its elasticity;
• reflection of ultrasound in the cavernous bodies. This is used to determine: the exact location of inflammation, the presence of pathologies, the development of fibrous plaques inside the penis and scrotum;
• dimensions (thickness and length) of the walls of the arteries in the penis;
• the speed of blood flow in the veins and vessels indicates the state of the circulatory system of the penis.

If, at the moment of full erection, the patient under examination experiences an outflow of venous blood, this indicates erectile problems.

The average cost of an examination in Moscow and St. Petersburg will be 1500-3000 thousand rubles. the price depends on the location, the quality of the equipment, and the professionalism of the diagnostician.

The disadvantage of Dopplerography of the vessels of the penis is the painful injection, which is administered to dilate the blood vessels, because of this, the subject may sometimes experience stress, and accordingly, an incomplete erection occurs or no erection at all. In this case, the patient can help himself with his hands or take Viagra.