Presentation Authors: Aaron Bradshaw*, SeungMo Yuk, Mahadevan Rajasekaran, Valmik Bhargava, Tung-Chin (Mike) Hsieh, San Diego, CA
Introduction: Previous color Doppler ultrasound (CDU) studies suggest penile macro-circulatory changes in patients with Peyronie&[prime]s disease (PD) leads to corporal veno-occlusive dysfunction. LSCI is a novel modality to evaluate penile microvascular perfusion (PMP) and our previous report has demonstrated the utility of LSCI in a mouse model. We sought to evaluate PMP changes in PD patients using novel LSCI in conjunction with macro circulatory assessment.
Methods: Patients undergoing penile CDU were recruited to undergo additional LSCI during the same encounter. CDU was performed at baseline, at 5 and 15 minutes post intracorporal injection of vasoactive agents. LSCI was performed at baseline, and with maximum achieved erection. Clinical variables, duplex results, and LSCI were compared to assess the utility of this new imaging modality.
Results: 6 patients underwent combined CDU and LSCI (median age 66.5 years). Indications for imaging were: 5 confirmed or suspected PD, and 1 refractory erectile dysfunction. CDU demonstrated arterial insufficiency (n=4) and venous leak (n=2). Baseline LSCI value ranged from 63 to 128 arbitrary units (AU) (mean 93 AU). 4 patients demonstrated PMP increase of 20% or greater with erection (range 0 to 179%), while 2 PD patients demonstrated only 0 and 3% increase. Figure shows moderate (top panel; >30%) and poor (bottom panel; < 5%) changes in PMP in 2 patients. The 2 PD patients with poor LSCI response had relatively different LSCI baseline (81 vs. 128 AU), age (69 vs. 39 AU), macrovascular pathology (venous leak vs. arterial insufficiency), and covariates (hypertension and smoking history vs. none).
Conclusions: This is the first report of LSCI to assess MVP of human penis, in PD. LSCI has the potential to be a non-invasive, non-operator biased technique to evaluate penile hemodynamic (microvascular) function. Further work is requisite to determine clinical utility of PMP assessment in conjunction with CDU to provide better understanding of penile perfusion and disease pathology. Observed poor responses suggest poor PMP in two PD patients which may possibly due to severe underlying fibrosis.
Source of Funding: UCSD academic senate