Results of ultrasound dopplerography of the penis in patients with before and after transurethral enucleation of benign prostatic hyperplasia

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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.

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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 Petersburg

Svetlana 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 Petersburg

Dmitriy 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 Petersburg

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Supplementary files

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2. Fig. 1. Doppler ultrasound of the vessels of the penis of patient V., 62 years old, BPH and arteriogenic erectile dysfunction. а – Before surgery: in the tumescence phase Vmax (maximum systolic blood flow velocity) 15.5 cm/s, RI (resistance index) 1.13; IIEF-5 13 points; b – 24 weeks after laser enucleation of the prostate (HoLEP), in the tumescence phase Vmax 40,4 cm/s, RI 1.04; IIEF-5 20 points

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3. Fig. 2. Doppler ultrasound of the vessels of the penis of patient E., 66 years old, BPH and venogenic erectile dysfunction. а – Before surgery: in the tumescence phase Vmax 37.7 cm/s, RI 0.65; IIEF-5 before surgery 14 points, Valsalva’s test is positive, the dorsal cavernous vein did not collapse and the blood flow through it was 20.5 ml/min; b – after bipolar enucleation of the prostate (TUEB): in the tumescence phase Vmax 41.1 cm/s, the discharge of blood through the dorsal cavernous vein decreased to 11.4 ml/min; c – after bipolar enucleation of the prostate: in the erection phase Vmax 58 cm/s, RI 1.07; IIEF-5 after surgery 20 points

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4. Fig. 3. Doppler ultrasound of the vessels of the penis of patient B., 59 years old, BPH and arteriovenogenic erectile dysfunction. а – Before the operation: in the tumescence phase Vmax 21.3 cm/s, RI 0.79, Valsalva’s test is positive, the dorsal cavernous vein did not collapse, the blood flow through it was 23 ml/min; IIEF-5 before surgery 13 points; b – after laser enucleation of the prostate (HoLEP): in the tumescence phase Vmax 37.5 cm / s, RI 0.96; IIEF-5 after surgery 21 points

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5. Fig. 1. Doppler ultrasound of the vessels of the penis of patient V., 62 years old, BPH and arteriogenic erectile dysfunction. а – Before surgery: in the tumescence phase Vmax (maximum systolic blood flow velocity) 15.5 cm/s, RI (resistance index) 1.13; IIEF-5 13 points; b – 24 weeks after laser enucleation of the prostate (HoLEP), in the tumescence phase Vmax 40,4 cm/s, RI 1.04; IIEF-5 20 points

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Indexing metadata
6. Fig. 2. Doppler ultrasound of the vessels of the penis of patient E., 66 years old, BPH and venogenic erectile dysfunction. а – Before surgery: in the tumescence phase Vmax 37.7 cm/s, RI 0.65; IIEF-5 before surgery 14 points, Valsalva’s test is positive, the dorsal cavernous vein did not collapse and the blood flow through it was 20.5 ml/min; b – after bipolar enucleation of the prostate (TUEB): in the tumescence phase Vmax 41.1 cm/s, the discharge of blood through the dorsal cavernous vein decreased to 11.4 ml/min; c – after bipolar enucleation of the prostate: in the erection phase Vmax 58 cm/s, RI 1.07; IIEF-5 after surgery 20 points

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Indexing metadata
7. Fig. 3. Doppler ultrasound of the vessels of the penis of patient B., 59 years old, BPH and arteriovenogenic erectile dysfunction. а – Before the operation: in the tumescence phase Vmax 21.3 cm/s, RI 0.79, Valsalva’s test is positive, the dorsal cavernous vein did not collapse, the blood flow through it was 23 ml/min; IIEF-5 before surgery 13 points; b – after laser enucleation of the prostate (HoLEP): in the tumescence phase Vmax 37.5 cm / s, RI 0.96; IIEF-5 after surgery 21 points

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