Results of ultrasound dopplerography of the penis in patients with before and after transurethral enucleation of benign prostatic hyperplasia
- Authors: Vydrin P.S.1,2, Kalinina S.N.1, Korenkov D.G.1
-
Affiliations:
- I.I. Mechnikov North-Western State Medical University
- Aleksandrovskaya Hospital
- Issue: Vol 11, No 4 (2021)
- Pages: 305-314
- Section: Original articles
- URL: https://journals.eco-vector.com/uroved/article/view/89701
- DOI: https://doi.org/10.17816/uroved89701
- ID: 89701
Cite item
Abstract
BACKGROUND: The development of modern technologies for the surgical treatment of urological diseases poses new questions for urologists. One of them is to evaluate the effect of transurethral enucleation of benign prostatic hyperplasia on the erectile function of patients.
AIM: The aim of the study was to assess the state of erectile function in patients before and after transurethral enucleation of benign prostatic hyperplasia using Doppler ultrasound of the vessels of the penis.
MATERIALS AND METHODS: The study included 102 patients with benign prostatic hyperplasia aged 50 to 80 years (average 65 years) with complaints of erectile dysfunction and urinary disorders. All patients underwent transurethral enucleation of benign prostatic hyperplasia: 55 patients with the laser method (HoLEP, group 1) and 47 patients – with the bipolar method (TUEB, group 2). The severity of ED was assessed using the IIEF-5 questionnaire (International Index of Erectile Function). To assess the state of blood flow in the penis, ultrasound dopplerography of the vessels of the penis was performed using a vasoactive erection stimulator. The studies were carried out before surgery and 24 weeks after it.
RESULTS: The results of ultrasound dopplerography of the vessels of the penis before surgery revealed the arteriogenic type of ED in 18 (17.6%) patients, the venous type – in 45 (44.2%) patients, the mixed arteriovenogenic type – in 22 (21.6%) patients. In 17 (16.7%) patients ED was regarded as psychogenic. 24 weeks after the operation in patients of both the 1st and 2nd groups, according to the data of the IIEF-5 questionnaire, positive dynamics of the severity of erectile function was noted, regardless of the type of ED. For patients with vasculogenic types of ED, similar trends were noted regardless of the type of surgery. Thus, in patients with arteriogenic and arteriovenogenic ED a significant increase in the maximum systolic blood flow velocity (Vmax) in the cavernous arteries was recorded, while the values of the resistance index (RI) did not change significantly. At the same time, the Vmax values in these patients were initially low before the operation, and after the operation did not reach the reference values. In patients with venogenic ED, there was no significant improvement in penile blood flow, as evidenced by the absence of significant differences in Vmax and RI values. At the same time, the RI in these patients before the operation was reduced, and the Vmax values were in the range of normal values.
CONCLUSIONS: The erectile function of patients after transurethral enucleation of benign prostatic hyperplasia improves regardless of the type of operation and the type of erectile dysfunction. Ultrasound dopplerography of the vessels of the penis is a minimally invasive and highly informative diagnostic method that makes it possible to detect circulatory disorders in the penis and assess its state in dynamics during treatment.
Full Text
![Restricted Access](https://journals.eco-vector.com/lib/pkp/templates/images/icons/text_lock.png)
About the authors
Pavel S. Vydrin
I.I. Mechnikov North-Western State Medical University; Aleksandrovskaya Hospital
Email: pavyd@yandex.ru
ORCID iD: 0000-0003-2711-7711
SPIN-code: 9031-2133
Postgraduate student Department of Urology, urologist
Russian Federation, Saint Petersburg; Saint PetersburgSvetlana N. Kalinina
I.I. Mechnikov North-Western State Medical University
Email: kalinina_sn@mail.ru
ORCID iD: 0000-0003-4280-3015
SPIN-code: 3359-2846
Dr. Sci. (Med.), Professor Department of Urology
Russian Federation, Saint PetersburgDmitriy G. Korenkov
I.I. Mechnikov North-Western State Medical University
Author for correspondence.
Email: dkoren@mail.ru
ORCID iD: 0000-0001-6215-8098
SPIN-code: 8569-1001
Dr. Sci. (Med.), Professor of the Department of Urology
Russian Federation, Saint PetersburgReferences
- Pushkar’ DYu, Rasner PI, Kharchilava RR. Lower urinary tract symptoms and benign prostatic hyperplasia. Urologiia. 2016;(2–2S): 4–19. (In Russ.)
- Salonia A, Bettocchi C, Carvalho J, et al. Sexual and Reproductive Health. Guideline of European Association of Urology. 2021. Available from: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Sexual-and-Reproductive-Health-2021.pdf. Cited: 2021 Dec 17.
- Braun MH, Sommer F, Haupt G, et al. Lower urinary tract symptoms and erectile dysfunction: co-morbidity or typical “Aging Male” symptoms? Results of the “Cologne Male Survey”. Eur Urol. 2003;44(5):588–594. doi: 10.1016/s0302-2838(03)00358-0
- Korneyev IA, Alexeeva TA, Al-Shukri SH, Pushkar DY. Lower urinary tract symptoms in male population of the Russian Federation North-Western Region: analysis of population study results. Urologicheskie vedomosty. 2016;6(1):5–9. (In Russ.) doi: 10.17816/uroved615-9
- Pushkar’ DJu, Kamalov AA, Al’-Shukri SH, et al. Analysis of the results of epide-miological study on prevalence of erectile dysfunction in the Russian Federation. Urologiia. 2012;(6):5–9. (In Russ.)
- Kogan MI. Erectile dysfunction (current opinion). Moscow: Borges; 2016. P. 160 (In Russ.) doi: 10.14300/mnnc.2016.11110
- Tiktinskii OL, Kalinina SN, Mikhailichenko VV. Andrologiya. Moscow: MIA; 2010. 576 p. (In Russ.)
- Mazo EB, Gamidov SI, Iremashvili VV. Erektil’naja disfunkcija. 2nd ed. Moscow: MIA; 2008. (In Russ.)
- Gupta N, Herati A, Gilbert BR. Penile Doppler ultrasound predicting cardiovascular disease in men with erectile dysfunction. Curr Urol Rep. 2015;16(3):16. doi: 10.1007/s11934-015-0482-1
- Köhler TS, McVary KT. The relationship between erectile dysfunction and lower urinary tract symptoms and the role of phosphodiesterase type 5 inhibitors. Eur Urol. 2009;55(1):38–48. doi: 10.1016/j.eururo.2008.08.062
- Al-Shukri SH, Kuzmin IV, Boriskin AG, Slesarevskaya MN, Kyrkunova SL. Correction of microcirculatory disorders in patients with overactive bladder. Nephrology (Saint Petersburg). 2011;15(1):58–64. (In Russ.)
- Shormanov IS, Solovyov AS, Tyuzikov IA, Kulikov SV. Anatomical, physiological and pathophysiological features of the lower urinary tract in gender and age aspects. Urology reports (St. Petersburg). 2021;11(3):241–256. (In Russ.) doi: 10.17816/uroved70710
- Kuzmin IV, Ajub AK, Slesarevskaya MN. Phosphodiesterase type 5 inhibitors in treatment of lower urinary tract dysfunctions. Urology reports (St. Petersburg). 2020;10(1):67–74. (In Russ.) doi: 10.17816/uroved10167-74
- Vydryn PS, Kalinina SN, Burlaka OO, Aleksandrov MS. Assessment of copulative function and severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia after transurethral enucleation. Urology reports (St. Petersburg). 2021;11(2):123–132 (In Russ.) DOI: 10.17816/ uroved55409
- Martov AG, Ergakov DV, Turin DE, Andronov AS. Bipolar and laser endoscopic enucleation for large benign prostatic hyperplasia. Urologiia. 2020;(1):59–63. (In Russ.) doi: 10.18565/urology.2020.1.59-63
- Robert G, Cornu JN, Fourmarier M, et al. Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int. 2016;117(3):495–499. doi: 10.1111/bju.13124
- Glybochko PV, Aljaev JuG, Rapoport LM, et al. Erectile function after endoscopic surgery for prostatic hyperplasia removal. Andrology and Genital Surgery. 2017;18(4):12–18. doi: 10.17650/2070-9781-2017-18-4-12-18
- Popov SV, Orlov IN, Grin YA, et al. State of copulative function in patients after the holmium laser enuсleation of benign prostatic hyperplasia. Urologicheskie vedomosti. 2019;9(2):17–22. (In Russ.) doi: 10.17816/uroved9217-22
- Anisimov NV, Kul’chavenja EV, Holtobin DP. Restoration of erectile function in men after prostate surgery in the immediate postoperative period: the needs assessment for patients and their partners to maintain sexual relations. Vestnik Urologii. 2021;9(3):12–18. doi: 10.21886/2308-6424-2021-9-3-12-18
- Briganti A, Naspro R, Gallina A, et al. Impact on sexual function of holmium laser enucleation versus transurethral resection of the prostate: results of a prospective, 2-center, randomised trial. J Urol. 2006;175(5):1817–1821. doi: 10.1016/s0022-5347(05)00983-3
- Kyzlasov PS, Martov AG, Popov SV, et al. Erectile dysfunction after transurethral surgery for benign prostatic hyperplasia. Journal of VolgSMU. 2017;(3):10–15. (In Russ.) doi: 10.19163/1994-9480-2017-3(63)-10-15
- Kyzlasov PS, Kasymov BG, Al-Shukri SK, et al. Radiation diagnostics of arteriovenous erectile dysfunction: history and development. Urologicheskie vedomosti. 2018;8(1):40–46. (In Russ.) doi: 10.17816/uroved8140-46
- Mihajlov MK, Lobkarev OA, Prokop’ev JaV. Prevalence and structure of erectile dysfunction and role of dynamic cavernozography in its diagnostics. Obshhestvennoe zdorov’e i zdravoohranenie. 2008;(1):94–98. (In Russ.)
- Kalinina SN, Burlaka OO, Aleksandrov MS, Vydryn PS. Diagnosis and treatment of lower urinary tract symptoms and erectile dysfunction in patients with benign prostate hyperplasia. Urologicheskie vedomosti. 2018;8(1):26–33. (In Russ.) doi: 10.17816/uroved8126-33
- Zhukov OB, Efremov EA, Shherbinin SN, et al. Dinamicheskaja komp’juternaja kavernozografija v diagnostike venook-kljuzivnoj jerektil’noj disfunkcii. Andrology and Genital Surgery. 2012;(1):55–58. (In Russ.)
- Kurbatov DG, Kuznetsky YY, Kitaev SV, Brusensky VA. Magnetic-resonance imaging as a potential tool for objective visualization of venous leakage in patients with veno-occlusive erectile dysfunction. Int J Impot Res. 2007;20(2):192–198. doi: 10.1038/sj.ijir.3901607
- Aljaev JuG, Chalyj ME, Sinicin VE, Grigorjan VA. Jehodopplerografija v urologii: Rukovodstvo dlja praktikujushhih vrachej. Moscow: Litterra; 2007. 168 p.
- Al-Shukri SH, Slesarevskaya MN, Kuzmin IV, Sozdanov PV. Role of high frequency doppler ultrasound in evaluating degree of erectile dysfunction. Smolensk Medical Almanac. 2018;(4):167–169 (In Russ.)
- Yildirim D, Bozkurt IH, Gurses B, Cirakoglu A. A new parameter in the diagnosis of vascular erectile dysfunction with penile Doppler ultrasound: cavernous artery ondulation index. Eur Rev Med Pharmacol Sci. 2013;17(10):1382–1388.
Supplementary files
![](/img/style/loading.gif)