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Pharmaco-écho-doppler pénien: méthodologie, critères diagnostiques et indications actuelles dans l’exploration d’une dysfonction érectile

Penile doppler ultrasound: diagnostic criteria and current indications in the management of erectile dysfunction

Basic and Clinical Andrology volume 22, pages2–9(2012)Cite this article

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Résumé

La dysfonction érectile (DE) est une pathologie multifactorielle fréquente, dont l’origine organique ou mixte est considérée actuellement comme dominante chez l’homme après 50 ans. La plupart des DE vasculotissulaires sont liées à une dysfonction endothéliale, en relation avec les principaux facteurs de risque cardiovasculaires (FRCV). La DE représente un indicateur de la santé vasculaire en général. Elle est aussi prédictive d’événements cardiovasculaires (ECV), notamment de coronaropathies. Elle a également été associée aux artériopathies des membres inférieurs et aux accidents vasculaires cérébraux. Le pharmaco-écho-doppler pénien (PEDP) est un examen assez peu utilisé aujourd’hui dans la prise en charge d’une DE, la recherche étiologique n’étant encore le plus souvent pas considérée comme nécessaire à la prise en charge thérapeutique, mais également en raison de l’absence de standardisation. Cependant, de nombreuses publications ont mis récemment en évidence que l’origine vasculotissulaire d’une DE, établie sur des critères vélocimétriques enregistrés après injection intracaverneuse (IIC) de substances vasoactives, renforçait la valeur prédictive de la DE concernant les événements et la mortalité cardiovasculaires (CV), justifiant un intérêt accru pour réaliser cet examen.

Abstract

Erectile dysfunction (ED) is a common multifactorial disease, whose organic or mixed origin is currently considered as dominant in men aged 50 years and older. Most ED classified as arterial are linked to endothelial dysfunction in relation to the key factors of cardiovascular risk. ED is an indicator of vascular health in general. It is also a predictor of cardiovascular events, including coronary heart disease. It has also been associated with lower peripheral arterial disease and stroke. The penile doppler ultrasound examination is actually used relatively infrequently in the management of ED, the etiologic factors being considered most often not necessary for the therapeutic management, but also because of the absence of standardization. Nonetheless, large recent studies have shown that the vascular nature of ED, basis on doppler parameters recorded after intracavernous injection of vasoactive drugs, strengthened the predictive value of ED on events and cardiovascular mortality, justifying a highest interest in this test.

Références

  1. 1.

    Virag R, Bouilly P, Frydman D (1985) Is impotence an arterial disorder? A study of arterial risk factors in 440 impotent men. Lancet 1:181–184

  2. 2.

    Feldman HA, Johannes CB, Derby CA, et al (2000) Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 30:328–338

  3. 3.

    Jackson G, Boon N, Eardley I, et al (2010) Erectile dysfunction and coronary artery disease prediction: evidence-based guidance and consensus. Int J Clin Pract 64:831–832

  4. 4.

    Montorsi P, Ravagnani PM, Galli S, et al (2006) Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J 27:2632–2639

  5. 5.

    Chung SD, Chen YK, Lin HC, Lin HC (2011) Increased risk of stroke among men with erectile dysfunction: a nationwide population-based study. J Sex Med 8:240–246

  6. 6.

    Polonsky TS, Taillon LA, Sheth H, et al (2009) The association between erectile dysfunction and peripheral arterial disease as determined by screening ankle brachial index testing. Atherosclerosis 207:440–444

  7. 7.

    Thompson IM, Tangen CM, Goodman PJ, et al (2005) Erectile dysfunction and subsequent cardiovascular disease. JAMA 294:2996–3002

  8. 8.

    Ma RC, So WY, Yang X, et al (2008) Erectile dysfunction predicts coronary heart disease in type II diabetes. J Am Coll Cardiol 51:2045–2050

  9. 9.

    Gazzaruso C, Giordanetti S, De Amici E, et al (2008) Erectile dysfunction as a predictor of cardiovascular events and death in diabetic patients with angiographically proven asymptomatic coronary artery disease: a potential protective role for statins and 5-phosphodiesterase inhibitors. J Am Coll Cardiol 51:2040–2044

  10. 10.

    Araujo AB, Hall SA, Ganz P, et al (2010) Does erectile dysfunction contribute to cardiovascular disease risk prediction beyond the Framingham Risk Score? J Am Coll Cardiol 55:350–356

  11. 11.

    Schouten BW, Bohnen AM, Bosch JL, et al (2008) Erectile dysfunction prospectively associated with cardiovascular disease in the Dutch general population: results from the Krimpen study. Int J Impot Res 20:92–99

  12. 12.

    Araujo AB, Travison TG, Ganz P, et al (2009) Erectile dysfunction and mortality. J Sex Med 6:2445–2454

  13. 13.

    O’Leary MP, Baum NH, Blizzard R, et al (2002) American Urological Association Gallup Survey: changes in physician practice patterns, satisfaction with urology, and treatment of prostate cancer and erectile dysfunction. J Urol 168:649–652

  14. 14.

    Desvaux P, Corman A, Hamidi K, et al (2004) Prise en charge de la dysfonction érectile en pratique quotidienne: étude PISTES. Prog Urol 14:512–520

  15. 15.

    Meuleman EJH, Hatzichristou D, Rosen RC, et al (2010) Diagnostic tests for male erectile dysfunction revisited. Committee Consensus Report of the International Consultation in Sexual Medicine. J Sex Med 7:2375–2381

  16. 16.

    AIHUS (Association interhospitalo-universitaire de sexologie) (2005) Recommandations aux médecins généralistes pour la prise en charge de première intention de la dysfonction érectile

  17. 17.

    Hatzimouratidis H, Amar E, Eardley I, et al (2010) Guidelines on male sexual dysfonction: erectile dysfunction et premature ejaculation. Eur Urol 57:804–814

  18. 18.

    Corona G, Fagioli G, Mannucci E, et al (2008) Penile doppler ultrasound in patients with erectile dysfunction (ED): role of peak systolic velocity measured in the flaccid state in predicting arteriogenic ED and silent coronary artery disease. J Sex Med 5:2623–2634

  19. 19.

    Aversa A, Sarteschi LM (2007) The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. J Sex Med 4:1437–1447

  20. 20.

    Kim SH, Paick JS, Lee SE, et al (1994) Doppler sonography of deep cavernosal artery of the penis: variation of peak systolic velocity according to sampling location. J Ultrasound Med 13:591

  21. 21.

    Montorsi F, Bergamaschi F, Guazzoni G, et al (1993) Velocity and flow volume gradients along the cavernosal artery: a duplex and color doppler sonography study. Eur Urol 23:357

  22. 22.

    Meuleman EJ, Diemont WL (1995) Investigation of erectile dysfunction. Diagnostic testing for vascular factors in erectile dysfunction. Urol Clin North Am 22:803–819

  23. 23.

    Pescatori ES, Hatzichristou DG, Namburi S, et al (1994) A positive intracavernous injection test implies normal veno-occlusive but not necessarily normal arterial function: a hemodynamic study (see comments). J Urol 151:1209

  24. 24.

    Aversa A, Bonifacio V, Moretti C, et al (2000) Re-dosing of prostaglandin-E1 vs prostaglandin-E1 plus phentolamine in male erectile dysfunction: a dynamic color power doppler study. Int J Impot Res 12:33–40

  25. 25.

    Benson CB, Aruny JE, Vickers MA Jr (1993) Correlation of duplex sonography with arteriography in patients with erectile dysfunction. Am J Roentgenol 160:71–73

  26. 26.

    Valji K, Bookstein JJ (1993) Diagnosis of arteriogenic impotence: efficacy of duplex sonography as a screening tool. Am J Roentgenol 160:65–69

  27. 27.

    Brandstetter K, Schwarzer JU, Bautz W, et al (1993) A comparison of color duplex sonography with selective penile DSA in assessing erectile dysfunction. Rofo 158:405–409

  28. 28.

    McMahon CG (1998) Correlation of penile duplex ultrasonography, PBI, DICC and angiography in the diagnosis of impotence. Int J Imp Res 10:153–158

  29. 29.

    Rajfer J, Canan V, Dorey FJ, et al (1990) Correlation between penile angiography and duplex scanning of cavernous arteries in impotent men. J Urol 143:1128–1130

  30. 30.

    Meuleman EJ, Bemelmans BL, van Asten WN, et al (1992) Assessment of penile blood flow by duplex ultrasonography in 44 men with normal erectile potency in different phases of erection. J Urol 147:51–56

  31. 31.

    Shamloul R (2006) Peak systolic velocities may be falsely low in young patients with erectile dysfunction. J Sex Med 3:138–143

  32. 32.

    Yavas US, Calisir C, Kaya T, Degirmenci NA (2007) A sign of arteriogenic insufficiency on penile doppler sonography: retrograde flow in penile cavernosal-spongiosal communications. J Ultrasound Med 26:1643–1648

  33. 33.

    Mancini M, Bartolini M, Maggi M, et al (2000) Duplex ultrasound evaluation of cavernosal peak systolic velocity and waveform acceleration in the penile flaccid state: clinical significance in the assessment of the arterial supply in patients with erectile dysfunction. Int J Androl 23:199–204

  34. 34.

    Teloken PE, Park K, Parker M, et al (2011) The false diagnosis of venous leak: prevalence and predictors. J Sex Med 8:2344–2349

  35. 35.

    Hellstrom WJ, Montague DK, Moncada IG, et al (2010) Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med 7:501–523

  36. 36.

    Meuleman EJ, Hatzichristou D, Rosen RC, Sadovsky R (2010) Diagnostic tests for male erectile dysfunction revisited. J Sex Med 7:2375–2381

  37. 37.

    Teh HS, Lin MB, Tsou IY, et al (2002) Penile colour duplex ultrasonography as a screening tool for venogenic erectile. Acad Med Singapore 31:165–169

  38. 38.

    Akkus E, Alici B, Ozkara H, et al (1998) Repetition of color doppler ultrasonography: is it necessary? Int J Impot Res 10:51–55

  39. 39.

    Kawanishi Y, Lee KS, Kimura K, et al (2001) Screening of ischemic heart disease with cavernous artery blood flow in erectile dysfunctional patients. Int J Impot Res 13:100–103

  40. 40.

    El-Sakka AI, Morsy AM (2004) Screening for ischemic heart disease in patients with erectile dysfunction: role of penile doppler ultrasonography. Urology 64: 346–350

  41. 41.

    Foresta C, Palego P, Schipilliti M, et al (2008) Asymmetric development of peripheral atherosclerosis in patients with erectile dysfunction: an ultrasonographic study. Atherosclerosis 197:889–895

  42. 42.

    Corona G, Monami M, Boddi V, et al (2010) Male sexuality and cardiovascular risk. A cohort study in patients with erectile dysfunction. J Sex Med 7:1918–1927

  43. 43.

    Inman BA, Sauver JL, Jacobson DJ, et al (2009) A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 84:108–113

  44. 44.

    Chew KK, Finn J, Stuckey B, et al (2010) Erectile dysfunction as a predictor for subsequent atherosclerotic cardiovascular events: findings from a linked-data study. J Sex Med 7(1 Pt 1):192–202

  45. 45.

    Miner MM (2011) Erectile dysfunction: a harbinger or consequence: does its detection lead to a window of curability? J Androl 32:125–134

  46. 46.

    Virag R (2002) Vasodilatation postocclusive des artères caverneuses. Un test potentiel de la réserve en NO du pénis. J Mal Vasc 27:214–217

  47. 47.

    Foresta C, Caretta N, Rossato M, et al (2004) Role of androgens in erectile function. J Urol 171:2358–2362

  48. 48.

    Caretta N, Palego P, Ferlin A, et al (2005) Resumption of spontaneous erections in selected patients affected by erectile dysfunction and various degrees of carotid wall alteration: role of tadalafil. Eur Urol 48:326–331

  49. 49.

    Aversa A, Greco E, Bruzziches R, et al (2007) Relationship between chronic tadalafil administration and improvement of endothelial function in men with erectile dysfunction: a pilot study. Int J Imp Res 19:200–207

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  1. 10-12, rue de France, Le Gibraltar, F-06000, Nice, France

    • C. Bonnin

  2. Cabinet médical Cheverny-Santé, 16, rue de la Poste, F-95000, Cergy-Pontoise, France

    • P. Bouilly

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Correspondence to C. Bonnin or P. Bouilly.

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Bonnin, C., Bouilly, P. Pharmaco-écho-doppler pénien: méthodologie, critères diagnostiques et indications actuelles dans l’exploration d’une dysfonction érectile. Basic Clin. Androl. 22, 2–9 (2012) doi:10.1007/s12610-012-0160-1

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Mots clés

  • Pharmacoécho-doppler
  • Dysfonction érectile
  • Pénis

Keywords

  • Penile doppler ultrasound
  • Erectile dysfunction
  • Penis

Basic and Clinical Andrology

ISSN: 2051-4190