| Objective:Erectile dysfunction(ED)is one of the most common diseases of male sexual dysfunction.Early diagnosis of ED patients and accurate identification of the cause can guide the clinical selection of individual treatment measures and effectively improve the quality of life in ED.The first part of this study aims to provide additional valuable auxiliary information for the etiological diagnosis of vascular ED,though the blood flow parameters(PSV,EDV,RI)and diameter change rate of the left and right cavernosal arteries of the penis were detected in the flaccid state and at 6 time points after ICI using Color Duplex Ultrasonography combined with intracavernous injection,dynamic analysis of the differences among artery ED venous ED and non-vascular ED,then seek the most suitable inspection time for this inspection.In the second stage of this study aims to investigate the value of SWE in assessing the hardness of the corpus cavernosum in ED patients,and to analyze the feasibility in the etiology identification of vascular ED though analysis of the trend of SWE-mean at 6different time points after ICI among arterial ED,venous ED and non-vascular ED.Methods:From December 2017 to October 2021,patient with the history of erectile dysfunction in the andrology outpatient department of our hospital,IIEF-5 score <21.91 patients were divided into AED group(29),VED group(26),and NVED group(36)according to CDU combined with ICI index.All patients were examined in the supine position,and were asked to gently hold the tip of the penis.Two-dimensional grayscale and color Doppler ultrasound and pulsed Doppler ultrasound were used to assess the penile corpus cavernosum structure and cavernosal arteries in the flaccid state.Peak systolic velocity(PSV),end-diastolic velocity(EDV),and resistance index(RI),cavernosal artery diameter(CAD)were recorded when the cavernosal artery showed at least 3 consecutive spectra.Then switch to SWE mode,select Pen mode for SWE imaging,and adjust it to the best image quality.The transverse section selects the base and tip of the penis for SWE imaging.At the same time,the Q-box of the machine was used to measure the SWE-mean of the base and the tip of the penis.After disinfecting the skin around the penis with iodophor,alprostadil 10 mg was injected into the nearly one-third of the lateral side of the right corpus cavernosum,and the audiovisual stimulation(AVSS)technique was applied.After ICI,six inspections and measurements were performed by the above two methods every 5 min from 5 min to30 min.The hardness of penile erection was graded according to the EHS scale before each measurement.Results?The first part of the study:(1)MPV,PC and EC in AED group were significantly higher than VED group and NVED group(P<0.05).(2)No significant difference in PSV,EDV and RI of the left and right cavernous arteries among the three groups(P>0.05).No significant difference in the diameter variation rate between the three groups before and after ICI(P>0.05).(3)PSV in the AED group was significantly lower than that of the NVED group and the VED group in the flaccid state and at six time points after ICI(all P corrected <0.05).However,no significant difference in PSV between NVED group and VED group in the flaccid state and at six time points after ICI(P>0.05).(4)No significant difference in the EDV between the VED group and the AED group and the NVED group in the flaccid state(P>0.05).From5 minutes after ICI,compared with the VED group and the AED group,the EDV in the NVED group was significantly different(P < 0.05),and this trend continued until 30 minutes.EDV was significantly different from between the VED group and AED group in 20 minutes after ICI(P < 0.05),and this trend continued until 30 minutes.(5)Compared with the VED group and the AED group,the RI in the NVED group was significantly different(P<0.05),from 5 minutes after ICI,and this trend continued until 30 minutes.Starting 15 minutes after ICI,RI was significantly different between the VED group and AED group(P<0.05),and this trend continued until 30 minutes.(6)The ROC curve of PSV in distinguishing AED from NVED was drawn.When the cut-off value was 8.81cm/s,the area under the curve was 0.706,the diagnostic specificity and sensitivity were 52.8% and 93.1%,respectively,and the accuracy was 69.4%.?The second part of the study :(1)Comparison of Base SWE-mean and Tip SWE-mean in all ED patients in the flaccid state and at six time points after ICI,the differences were statistically significant(P<0.05).The SWE-mean of Base and Tip were significantly higher in the three groups when the penis sponge was flaccid than at six time points after ICI(P<0.05).(2)No significant difference in Base SWE-mean and Tip SWE-mean between the AED group and the NVED group in flaccid state(P>0.05).The Base SWE-mean and Tip SWE-mean of the AED group were significantly higher than those of the NVED group at 6 time points after ICI(P<0.05).Drawing the ROC curve of AED: the area under the Base SWE-mean curve was the largest 0.801 at 10 minutes after ICI,so the Base SWE-mean at 10 minutes after ICI was the most meaningful for the diagnosis of arterial ED.(3)No significant difference in Base SWE-mean between the VED group and the NVED group at 5min,10 min,15min after ICI and in the flaccid state(P>0.05).At 20min?25min?30min after ICI,the Base SWE-mean of VED group was significantly higher than that of NVED group(P<0.05).No significant difference in Tip SWE-mean between the VED group and the NVED group in the flaccid state and at 6 time points after ICI(P>0.05).The Base SWE-mean in the VED group increased from 15 to 25 minutes after ICI,but not in NVED;the ROC curve of VED shown: Base SWE-mean has the highest diagnostic value for the VED group at 20 minutes after ICI,and the AUC can reach 0.632;(4)Base SWE-mean 5 min after ICI and Tip SWE-mean 10 min after ICI AED group was significantly higher than VED group,(P<0.05),Base SWE-mean and Tip SWE-mean of AED group and VED group at other time points after ICI There was no statistical difference(P>0.05).(5)The SWE-mean of Base and Tip at each time point after ICI was negatively correlated with EHS at the corresponding time point.(6)The age of ED group was negatively correlated with Base SWE-mean and Tip SWE-mean.The Base SWE-mean correlation was greater than the Tip SWE-mean correlation(r=0.601,0.564,respectively).Conclusion? The first part of the study:CDU combined with ICI,as the first-line method for the diagnosis of vascular ED,can be well used to determine the subtypes of vascular ED.In this study,dynamic analysis of PSV,EDV and RI at 6 time points after ICI in three groups of AED,VED and NVED was performed.It was found that the PSV value can be passed from 5 minutes to 30 minutes after ICI,which can be used for the differential diagnosis between the patients with arterial ED and the other two groups.PSV in the flaccid state has a certain predictive value for arterial ED;RI and EDV in the venous ED group and the non-vascular ED group began to differ 5 minutes after ICI.Significant differences between the venous ED group and the arterial ED group started 15 min after ICI,while the EDV between the two groups began to show significant differences after 20 min.In conclusion,CDU combined with ICI to check the dynamic multi-time point measurement,understand the difference of blood flow parameters between different groups at each time point,can effectively reduce the occurrence of false positive rate and false negative rate,and can better improve the diagnosis and differential diagnosis rate of vascular ED At the same time,the inspection time must reach 20 min to obtain better diagnostic performance.?The second part of the study:(1)SWE can accurately and quantitatively evaluate the hardness of the corpus cavernosum in ED patients in any state.(2)Base and Tip SWE-mean in the arterial ED group were higher than those in the non-vascular ED group at any time point after ICI.(3)Base SWE-mean 10 minutes after ICI has the highest diagnostic value for arterial ED.Comparison of SWE values between the venous ED group and the non-vascular ED group: Base SWE-mean in the venous ED group was higher than that in the non-vascular ED group at 20?25?30 minutes after ICI.From 15 minutes to 25 minutes after ICI,the SWE-mean at the base of the corpus cavernosum showed an increasing trend in the venous ED group,but not in the non-vascular ED group.20 minutes Base SWE-mean had the highest diagnostic value for the VED group.(4)Base SWE-mean and Tip SWE-mean 10 min after ICI in arterial ED group were higher than those in venous group.However,the trend of SWE values in the two groups over time needs to be further expanded to study the sample size and related factors.(5)As the age increases,the Base and Tip SWE-mean are lower.In short Shear Wave Imaging technology can accurately and quantitatively evaluate the hardness of the corpus cavernosum in ED patients,and can provide valuable information for the identification of vascular ED and non-vascular ED through the change of SWE value over time. |
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