J Korean Radiol Soc 1997; 36: 1047-1052

Diagnostic Value ofDouble Injection ofVasoactive Drug in Penile Doppler Ultrasonographyl

Seung Yon Baek, M.D., Hye Young Choi, M.D., Sun Wha Lee, M .D., Woo Sik Chung, M.D. 2

Purpose : To evaluate the usefulness of double injection of a vasoactive drug in penile Doppler ultrasonography for the diagnosis ofvasculogenic impotence.

Materials and Methods: Eighty-four consecutive cases(bilateral sides) of 42 patients with suspected vasculogenic impotence were included in our study. We used computed sonography(Acuson, USA), with a 7 MHz linear array transducer. After the first intracavernosal injection of the vasoactive drug( lOμg of prostagladin E 1), peak systolic velocity(PSV) and end diastolic velocity(EDV) were measured three times. Ac­cording to mean PSV and EDV, the patients were classified into four groups: arteriogenic impotence(AI; N = 29), venogenic impotence(VI; N = 28), AI associated with VI(N= 14), and normal(N= 13). After the second injection, PSV and EDV were remeasured , using the same method. Mean velocities of the first injection were compared with those of the second, and the paired t-test was used to analyze the results. The extent to which patients were reclassified after the second injection was noted.

Results : In all four groups, PSV measured after the second injection was signifi­cantly different from PSV after the first(P=O.OOOl , 0.0001 , 0.0010, 0.0072) ; except in the normal group, EDV measured after the second injection was not different from EDV afterthe first (P = 0.9815, 0.0654, 0.0950, 0.0057).

After the second injection, the numbers of patients reclassified into other groups were as follows : AL 11(38%); VI, 6(21 %); AI associated with VI, 11(79%); normal, 1 (8%).

Conclusion : Double injection of a vasoactive drug affected PSV, and therefore, appears to be a useful adjunctive procedure for the evaluation of patients in whom classification based on the results ofthe first injection is difficult.

IndexWords: Penis, US Ultrasound(US), Doppler studies

Penile Doppler ultrasonography after injection of vasoactive pharmacologic agents inducing an erection is important in the diagnosis of vasculogenic erectile dysfunction(l , 2). In 1985, Lue et al. reported duplex ultrasonography as a noninvasive tool in the evalu­ation of penile circulation(3). The advent of color Doppler imaging allows not only high resolution

'Department of Radiology , Co llege of Medicine, E wha Womans U niversity ' Department of Urology, College of Medicine, Ew ha Womans Uni versi ty Received March 4, 1997; Accepted May 19 , 1997

Address reprint requests to: Seung Yon Baek, M .D., Ewha Womans University Mokdong Hospital ~ 911-1 Mok-Dong, Yangch eon-Ku SeouL 158-056, Korea Tel: 82-2-650-5174, Fax: 82-2-644-3362

imaging of vessels and tissue features but also display of flow characteristics and results in rapid and accu­rate acquisition of Doppler data( 4). Increase of arterial inflow and restriction of venous outflow are important to penile erection , Inflow is impaired by atheros­clerotic changes in the cavernous inflow tract and veno-occlusive dysfunction occurs when there is ana­tomical or functional abnormalities of the cavernous body(5). However, sometimes psychic impact may in­fluence to prevent an erection even in the person with normal erectile function ,

Several pharmacologic agents have been used in

1047

Seung Yon Baek et a/: Diagnostic Value of Double Injection of Vasoactive Drug in Penile Dop미er Ultrason명raphy

penile Doppler ultrasonography and these are pa­paverine hydrochloride, prostaglandin E1 , phentola­mine mesylate and atropine sulfate(6 - 9). Many studies included single or combined drugs to evaluate vasculogenic impotence(6 - 9). But there have been few studies of using double injection of single or combined vasoactive drugs( lO, 11). Double injection may relieve or lessen the psychic impact and attain the complete relaxation ofpenile smooth muscle, therefore it may produce more accurate diagnosis for the vasculogenic impotence.

The objectives ofthis study are to evaluate whether there are significant differences in the peak systolic and end diastolic velocities between single and double injection of vasoactive drug and whether the method of double injection may influence the diagnosis of vasculogenic impotence.

Materials and Methods

Penile Doppler ultrasonography had been per­formed in 396 cases of 198 patients with suspected vasculogenic impotence during one year and eight months. Out of them, eighty-four consecutive cases(bi­lateral sides) of fourty-two patients with double injec­tion of vasoactive drug were included in our study. The indications of double injection were PSV less than 30 cm/sec and/or EDV more than 5 cm/sec. The patients were 23 to 75 years old(mean, 47years).

We used an Acuson computed sonography 128 X/P1 o unit with 7MHz linear array transducer. Doppler sonography was performed with the patients in supine and the penis in the anatomic position. Doppler spec­trum was obtained since 3 minutes after first in­tracavernosal injection of 10 μg of prostaglandin El (PGEl) using a 25 gauge needle. Doppler angle was kept less than 60 degrees, sample volume and wall fil­ter were fixed at minimum. The transducer was placed on the ventral side and Doppler spectrum was obtained at the base of the penis where the cavernosal artery angles posteriorly into the crus of the corpus cavernosum. Doppler spectra were obtained three tImes Table 1. Comparison Peak Systolic Velocities after First In­jection

Group(No) First PSV Second PSV P value

AI(29) 17.0 25 .5 0.0001 VI(28) 35.3 43.1 0.0001 Alwith VI(l 쇠 20.7 28.5 0.0010 Normal(13) 26.8 33.0 0.0072 All(84) 25.3 33.1 0.0001

Velocities : cm/second

with 5 minute interval in both sides andpeak systolic velocities(PSV) and end diastolic velocities(EDV) were measured and mean velocities were calculated. The patients with less than 30cm/sec of PSV and/or more than 5 cm/sec of EDV were taken second injection of PGEl with the same method. PSV and EDV were remeasured with the same method.

According to the results ofPSV(normal > 25 cm sec) and EDV(normal < 5 cm/sec) measured after the first injection of PGE1 , the patients were classified into 29 cases of arteriogenic impotence(AI)(PSV < 25 cnÍ /sec), 28 cases of venogenic impotence(VI) (EDV > 5 cm/sec), 14 cases of AI associated with VI(PSV < 25 cm/sec,

EDV> 5 cm/sec) and 13 cases of normal. Mean velocities of the first injection(first velocities) were compared with those of second injection(second velocities) and analyzed with paired t-test. We evaluated how many cases of initial groups with the first in jection were reclassified into the other groups after the second injection.

Results

In all four groups, first PSV after single injection was statistically different from second PSV after double in­jection(Table 1). In AI group, the first PS':'- (M= 17.0 cm/sec) measured after single injection was statistically different from the second PSV(M = 25. 5 cm/sec) after double injection (P=O.OOO l). In VI group, the first PSV(M=35.3cm/sec) was different from the second PSV (M=43.1cmβec)(P=O.OOOI). In AI associated with VI group, the first PSV (M = 20.7 cm/sec) was dif­ferent from the second PSV(M= 28.5cm/sec)(P=0. 0010). In normal group, the first PSV (M = 26.8cm/sec) was different from the second PSV(M = 33.0cm/sec)(p = 0.0072). In total 84 cases, the first PSV (M = 25.3 cm/sec) was different from the second PSV(M = 33.1 cm/sec)(p = 0.0001)

The first EDV in each group measured after single in­jection was not different statistically from the second EDV after double injection except normal gro때(Table 2). In normal group , the first EDV(M = 2.67 cm/sec) was

Table 2. Comparison End Diastolic Velocities after First In jection with End Diastolic Velocities after Second Injection

Group First EDV Second EDV P value

AI(29) 2.57 2.55 0.9815 VI(28) 8.02 7.04 0.0654 AlwithVI(14) 6.20 4.93 0.0950 Normal(13) 2.67 0.87 0.0057 A1l(84) 5.42 4.62 0.0101

Velocities: cm/second

-1048 -

J Korean Radiol Soc 1997; 36: 1047-1052

different from the second EDV(M = 0.87 cm/sec)(p = 0.0057). In tota1 84 cases, the first EDV(M=5.42 cm/sec) was different from the second EDV(M = 4.62 cm/sec)(P=O.OlO l) . But in AI group , the first EDV (M = 2.57 cm/sec) was not different statistica11y from the second EDV(M=2.55cm/sec)(P=0.9815). In VIgroup, the first EDV(M = 8.02crr냉ec) was not diffferent from the second EDV(M= 7.04cm/sec)(P=0.0654). In AI as­sociated with VI group, the first EDV (M=6.20cm/sec) was not different from the second EDV (M = 4. 93 cm/sec)(p = 0.0950)

After doub1e injection of vasoactive drug, out of 29 AI patients, five patients (17 %) were reclassified into norma1(Fig. 1) 뻐d six(21 %) into VI, therefore tota111 patients(38%) of AI were reclassified. Out of 28 VI patients, five patients(18%) were reclassified into nor­mal(Fig. 2) and one(4%) into AI and tota1 six(21 %) were reclassified. Among 14 patients with AI associated with VI, four(29 %) were reclassified into normal and four(29 %) into AI and three(21 %) into VI, therefore 11 patients(79%) were reclassified. Among 13 norma1 persons, one person(8 %) was reclassified into AI.

Therefore, 29 of 84 cases(35 %) in a11 four groups were

reclassified into other groups(Tab1e 3).

Discussion

Erectile dysfunction defined as an inability to gener­ate or maintain an erection adequate for sexua1 activity results from organic disease in 50 - 90% of cases( 12, 13). Most cases are a result of hemodynamic dysfunc­tion with arteria1 and/or venous incompetence. The par없neters to indicate arteria1 disease are subnorma1 clinical response to vasoactive drug, 1ittle or no arteria1 dilatation and a peak systolic ve10city 1ess than 25 cm/sec(3, 14). Mean end diastolic velocity greater than or equa1 to 5 cm/sec shou1d be considered as venogenic impotence(4, 15).

Hemod ynamic changes in the erectile response re­vea1 relaxation of the smooth muscle of the cavernosa1 arterio1es and sinusoids, resulting in their dilatation and an increase in b100d flow. The filling and disten­sion ofthe sinusoids against the indistensib1e tunica a1-buginea results in the mechanica1 compression of the draining venu1es between the sinusoida1 wa11s and the tunica, effectively restricting venous outflow(12) .

Table 3. Reclassification of Groups after Double 1띠ection

Initial Group AI VI AI with VI Normal Reclassified

AI(29) 18 (62%) 6 (21 %) o (0%) 5 (17 %) 11 (38%) VI(28) 1 (4%) 22 (78%) o (0 %) 5 (18%) 6 (21 %) AI with VI (14) 4(29 %) 3 (21 %) 3 (21 %) 4(29%) 11 (79%) Normal (13) 1 (8 %) o (0 %) o (0 %) 10 (92%) 1 (8%) All (84) 24(29 %) 31 (38%) 3 (4%) 24(29%) 29 (35 %)

B

Fig. 1.40 year old male with suspected vasculogenic impotence. A. The peak systolic velocity (PSV) and end diastolic velocity (EDV) of first injection of vasoactive drug revealed 20cm/sec and 2cm/sec respectively, suggesting arteriogenic impotence. b. PSV and EDV after second injection revealed 28cm/sec and Ocm/sec respectively, suggesting normal range. Therefore arteriogenic impotence after first injection was reclassified into normal after second injection.

- 1049

Seung Yon 8aek et a/: Diagnostic Value of Dou비e Injection of Vasoactive Drug in Penile Dop미er Ultrason명raphy

A B

Fig. 2. 45 year old male with suspected vasculogenic impotence. A. PSV and EDV after first injection of vasoactive drug showed 27 cm/sec and 7 cm/sec respectively, those were correspond mg to venogemc lmpotence. B. PSV and EDV after second injection showed 49cm/sec and 3cm/sec, respectively and those were corresponding to normal range. Therefore venogenic impotence a잠er first i띠ection was reclassified into normal after second injection.

Normal erectile function requires normal vasculo genic, neurogenic and psychogenic factors . For the patient suggestive of erectile dysfunction, neurogenic and endocrine abnormalities can be evaluated through clinical history, endocrine assays and physical examin­ation(l6). The evaluation of hemodynamic factors requires a more invasive analysis of arterial flow and venous competence by means of internal pudendal arteriography and dynamic infusion cavernosometry. The arteriography with vasoactive drug injection is considered as gold standard for the evaluation of penile inflow and provides accurate anatomical information, but this study is invasive, expensive, time-consuming, and painful(16). There are a variety ofways to analyze arterial inflow indirectly, including Doppler sono­graphy, plethysmography and penile blood pressure measurement(17).

Duplex Doppler ultrasonographic assessment of penile blood flow is one ofthe best screening tools cur­rently available(1 , 2) and replaces the selective arteriography progressively. Several studies have revealed that penile Doppler ultrasonography corre­lates with selective arteriography with 90 - 95 % ofthe cases(18, 19). In addition, the advent of color flow has been useful in detection and visualization of some smaller cavernosal arteries(6).

Many investigators proposed various cutoff values for differentiating normal from vasculogenic impo­tence. The proposed value of peak systolic velocity in­clude 25 - 40cm/sec{1, 2, 4, 12, 20, 21) and the upper normallimit of end diastolic velocity is 5 cm/sec{ 4, 15). The broad range of cutoff values may be explained by

variety of standards for arterial function, differences in the study population, intrinsic differences among types of equipment, inappropriate angle ofinsonation, inherent diffraction and side-lobe artifact( l, 15). We have used 25 cn파ec as the lower normal range of PSV and 5 cm/sec as the upper normal range of EDV. There is no reports about diagnostic cutoffvalues ofthe peak systolic velocity and the end diastolic velocity for double injected cases. Therefore, we used same cutoff value ofnormal velocity in single injection as well as in double injection

Various technical modifications for Doppler ultrasonography have been introduced, such as the type and dose ofvasoactive drugs, the time interval be­tween intracavernosal injection ofvasoactive drug and Doppler examination, the indices and the sampling 10-cation measured on Doppler spectral analysis (13, 22, 23).

Psychological factors influence peak velocity measurement and waveform progression(1 , 15). In very anxious patients, sympathetic discharge prevent dilatation of the cavernosal arteries in response to vasoactive drug and cavernosal arterial value may suggest arterial insufficiency erroneously. To over­come the vasoconstriction in anxious patient, adequate dosing sucL as multidosing of single or combined drugs was injected intracavernosally to decrease sympathetic outflow and then the evaluation of erectile dysfunc­tion could be enhanced( lO, 11). Katlowitz et al(lO) reported that overall response to multidosing was 51.

5%(17 /33) of their cases. In our study, by means of double injection of vasoactive drug, patient ’s anxiety

- 1050 -

않뼈 짜싸싸%

앉 았짜 뼈 m뼈 %

m

h빵 μ빼뼈 %“빠 뼈

샤사

J

#매”L

띠사사ω%

삐 m“J

·m엉 m

m

•4

%

m

뼈샤M ?‘

때 識때뼈때 빼빼캔 빽써밤m 뼈%빼 빼잃빼뼈

m

m뺨| 뼈

U- n

%싸앙따 M때따

‘

씨 m·낀

m」R

P%α m S

혀 따때 때

αι t

삐ιM

“ι녀뼈 L씨↓ω뼈 때갱않ι… 뼈7 야ι 뼈 띠 ”아 W%m

m

dm

W띠mm m빼 e

메

m뼈 ，뺑l m5

mn

빽，때 야 mmE

r

빼 때%V

뼈m

‘

@빼 없 m

껴hJα 때뻐w ghι%때때“

K파

때 m

씨 깨ν째 에 따 따 ”m，때 없 ”M%

뺨싸 야때앉때 쐐애써때ιω-ν·

” 짧

않 m

때 뼈빼 〔ι”짜m 빼’t뼈 띠에 뼈1μμ씨뻐μU

m

빡m gkmmpm

pm

째 뼈싫삐 빼써떠·m R

않

a

ιX뻐 Kπu맹J

평Jω Xm∞까씨 않이 n 6

m’

F

“ m m

L

뼈 y

TA

앉」@ r&

d

w mm

매ιω mvm

m

값

M?”￠L &띠 mγ때 a

대샤때 C

E때‘mm‘짜m ’mμMι시M뼈J 빠ι”

따 야J DLιLU ‘ι 때 때 셔ω싸ω빠 J」짜ιμNμ빠-mM m

rmm·%띠에 5

껴8

K찌찌띠 야 뼈 없 쩌Jmh mγ따pm뼈μ 빽% 짧때J%W

M

M페표

값 mmj

Rι

m3

뼈 ”“‘m

&LC

때

뻐 m야 Ke냉nmbA 여뼈A 없 없다@n

S

히”ι 히 F사ω

씨M @

n

z

m

yA

M아R

mh{m「”ι

때 m

P

빠 야l

뼈 m윈Km싸 AJd·m

삐뼈 반성

i nA

때 맹mNMbM m

m r L

m

m

띠2L

랴

N

따 값

잃 녀 m3μmn

m

뻐 mA

1

m

L

，하‘”k;

」

에사값 띠W따η t

m삐 니

m m%

m

빠fn m꽉*ν셰

빵띠

m n

mJ띠 mfK샤M

때뼈%빼

씨빼뼈뼈띠뼈쨌빠빼

m%

빼빼빼뻐따뼈뼈뼈

떼째빠빼뼈빼뼈

?m

mmnG

n@mNk”kM6S

때 amηιN 따P 앞

L

서에SR

”M m았띠미

M디 -

9

m

n

u

n

M

πu

“ω

n

m

g싸뼈빠 따 따·빵w m

없샤앙싸찌니때〔페시카

L야 .m뼈 m때 때“싸

m m

따“과“b마 Mm

”m

%·없 않pmm

m

따 M빠파

%

m m

·Ym때

mw

m때%」빠따

ιmω

(

nFιum

앉 없싸따없아

h 찌Fm‘%빼

m -m

때빠

R

업뼈 없

%

때 싸띠없따

떠뼈“앉 때빼야 뺑씨ω시m m

뻐

H

mrπ따 때 @

때 따 m

-mι야 얘 -

뼈뼈熾

R

때 떼빠 u뺑a

e

빵빼빼뺑때

m뺑m빼ιm빼 ”꾀 뻐 없싫

m

빽뺑때떼

없뼈따뼈 따삐뼈 없 때벡“빽뼈

껴M 빠 빼 뼈 m

e

띠O 따

m

」뼈 없 e

앙사야 m

뼈 m1πm

-m때 m엉m Rιω 씨에 빠“뼈때

@

갱d 앉 앉 까

m %1n

m /

mJl

e e P

￡ n

R

따 띠m m

때얀띠이 빼뼈뺑뼈

E

야m빼싸빵m 쩨 M

따뼈 m

M떼 않 빽햄h 뼈 빠삐“따

κ mh빡m빼 mm빼이빽뺑빼뻐않

없 없뼈싹

m

뼈빼빼

빼째빼때熾

뺑빼빼뼈敏뺑때빼따빼뼈뺑

m 뼈 때m빼빽뺑째빼빼爛熾

뺑빼熾

뼈빼빼m 鋼m빼m때뼈뼈

繼빼熾빼

야 따냄 짧 페“

ej빼 뻐

때 애 k써빵떼

A뻗따

m

없따아

E

m r

았 W갱양뼈때

았

뺑않 hι원 삐φ

뺑퍼따 --빠

8

띠S

맹

9

짧 敏hm떼 뼈 m뼈빼뺑m뼈 야짧 m떼h

m빼삶뼈

m때

m

애썩뺑때빡바때

때뼈 빼뼈뼈h 않敏뼈때빼빼따뼈

”뺑뼈빼

m뺑빼織願

폐뺑願

빼 빡빼빼빼鋼빼빼

m때뺑빼뼈

熾爛mm빼 때熾빼

뼈鋼mm뺑빼 빽빼빼

빼빼때빼빼

鋼뼈빼뼈

뼈빼빼隨施

m짧따 織뼈때m빼@ 때뺑쩨m爛뼈m 빼 뺑m뺑鋼m 빽때뼈

뼈빼빼

빼熾m뺑”M뼈따뺑m때파뼈빠빠때떼

m따m빼빼빼빼

뼈뼈

때 폈뼈 없 뺑때빼m빡뺑쨌빼

액쩍빼

P

빼때M바 m빼

%

m빠빼났 m따 따 mm뺑빼뼈 빽빼 뺑뼈

R

빼책빼뼈&旅빼뼈

mm

m熾M

뼈 f

Jω 뼈A앉빼 C

때 M

m갱d

g

m m

jh

m

따니 ·R

t끼 W

m

ι

m

m빼 m

뼈 쩌갱앉떼

nι& j써씨싸앙않

’

e씨띠싸매

7m l

따

빼 따

p앉 m깅 mr따 m4m

mrm

F

n야삐 뼈 없 따 m따μ뼈뼈 따뼈 ?m

따삐

7

nm

·없 웰뼈 때 없 떠m m밟 ·m

m짜ωμm @때 m

m액까씨싸M돼 U

” m

M

·빼

J Korean Radiol Soc 1997; 36 : 1047-1052

are considered equivocally as AI or AI combined with VI after first injection.

References

l. Benson CB, Aruny JE, Vickers Jr MA. Correlation of duplex

sonography with arteriography in patients with erectile dys­

function. AJR 1993; 160: 71-73

2. Valji K, Bookstein JJ. Diagnosis of arteriogenic impotence: effi­

cacy of duplex sonography as a screening tool. AJR 1993; 160:

65-69

3. Lue TF, Hricak H, Marich KW, Tanagho EA. Vasculogenic im

potence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radi%gy 1985; 155:

777-781

4. Quam JP, King BF, James EM et al. Duplex and color Doppler

sonographic evaluation of vasculogenic impotence. AJR 1989; 153 ’ 1141-1147

5. Meuleman EJH, Bemelmans BLH, Van Asten WNJC, Doesburg

WH, Skotnicki SH, Debruyne FMJ. Assessment of penile blood

flow by duplex ultrasonography in 44 men with normal erec­

tile potency in different phases of erection. J Uro/ 1992; 147 :

51-56

6. Lee LM, Stevenson RWD, Szasz G. Prostagladin E1 versus

phentolamine/papaverine for the treatment of erectile impo­

tence. J Uro/ 1989; 141 ; 549-550

7. McMahon CG. A comparison of the response to the

intracavernosal injection of a combination of papaverine and

phent이amine， prostagladin PGE1 and a combination of all three

agents in the management of impotence. Int J Impotence Res

1991 ; 3 : 113-121 8. Virag R, Shoukry K, Floresco J , Nollet F, Greco E

Seung Yon 8aek et a/: Diagnostic Value of Double Injection of Vasoactive Drug in Penile Dop미er Ultrason여raphy

18. Velcek D, Sniderman KW , Vaughnan ED, Sos TA , Muecke EC.

Penile flow index utilizing a Doppler pulse wave analysis to

identify penile vascular insufficiency. J Uro/ 1980; 123: 669-672 19. Lane RJ, Appleberg M, Williams W. A comparison of two

techniques for the detection of the vasculogenic component of impotence. Surg Gynec & Obst 1982; 155; 230-234

20. Benson CB, Vicker MA. Sexual impotence caused by vascular

disease: diagnosis with duplex sonography. AJR 1989: 153; 1149-1153

21. Fitzgerald SW, Erickson SJ, Foley WD, Lipchik EO, Lawson TL. Color Doppler sonography in the evaluation of erectile

dysfuction: pattern of temporal response to papaverine. AJR

1991; 157: 331-336 22. Kim SH, Paick JS, Lee SE, Choi B1, Yeon KM, Han MC. Doppler

sonography of deep cavernosal artery of the penis: variation of

peak syst이ic velocity according to sampling location. J

U/trasound Med 1994; 13: 591-594

23. Chung WS, Park yy , Baek SY. The effect of measurement 10

cation of the blood flow parameters on their values during

penile duplex sonography. Korean J Uro/1994;35 : 1347-1352

24. Reiss H. Use of prostagladin E1 for papaverine-failed erection. Ur% 없 1990;33: 14-16

25. Waldhauser M, Schramek P. Efficiency and side effects of prostaglandin E1 in the treatment of erectile dysfunction. J

Urol 1988; 140: 525-527

26. Floth A, Schramek P. Intracavernous injection of prostaglandin

El in combination with papaverine ‘ enhanced effectiveness in

comparison with papaverine plus phent이amine and

prostagladin E1 alone. J Uro/ 1991; 145: 56-59

대한밤사선의학회지 1997; 36: 1047-1052

음경도플러초음파검사에서 발기유발약제의 이중주사의 진단적 가치1

l 이화여자대학교 의과대학 방사선과학교실

2이화여자대학교 의과대학 비뇨기과학교실

백 숭 연 · 최 혜 영 · 이 선 화 · 정 우 식2

목 적 · 발기유발약제를 이중주사한 후에 실시한 음경도플러초음파검사가 혈관성발기부전을 진단하는데 유

용한지를 알아보고자 하였다.

대상 및 방법 . 혈관성발기부전이 의심되어 음경도플러초음파검사를 실시하였던 연속적인 환자 42명의 양측

음경해면체동맥 84예를 대상으로 하였다. 사용한 초음파 기기는 Computed sonography(Acuson, USA)이며 7

MHz의 선형탐촉자를 사용하였다. 발기유발약제로 prostagladin E1(PGE l) 10앵을 음경해면체내에 첫번째

주사한 후에 양측 음경해면체 동맥에서 최고수축기유속(PSV)과 확장말기유속(EDV)을 각각 세번 측정하였

다. 평균유속에 따라 대상을 동맥부전군(N = 29) , 정맥부전군(N = 28) , 혼합군(N = 14)과 정상군(N = 13)으로 나누었다. 동량의 PGE1을 두번째 주사한 후에 PSV와 EDV를 같은 방법으로 측정하였다. 첫번째 주사후의 평

균 PSV, EDV와 두번째 주사후의 평균PSV와 EDV가 차이가 있는지 쌍 t 검정을 이용하여 분석하였다. 또한 첫번째 주사후에 측정된 유속에 따라 분류된 네군 각각에서 두번째 주사후의 변화된 평균유속에 따라

다른군으로 얼마나 재분류되었는지를 알아보았다.

결 과 : 네군 각각에서 두번째 PSV는 첫번째 PSV와 통계학적으로 의미있게 차이가 있었다(P = 0.0001, O. 0001, 0.0010, 0.0072) . 그러 나 EDV는 정 상군을 제 외 하고는 두번째 EDV와 첫 번째 EDV간에 통계 학적 으로 차

이가 없었다(P = 0.9815, 0.0654, 0.0950, 0.0057).

두번째 주사후의 평균 PSV와 EDV의 수치에 따라 동맥부천군의 11예 (38%) ， 정맥부전군의 6예 (21%) ， 혼합

군의 11예 (79%)와정상군의 1예 ( 8%)가다른군으로재분류되었다.

결 론 : 발기유발약제의 이중주사법은 PSV에 영향을 미치므로 첫번째 주사후 동맥부전군과 혼합군으로 평

가된 환자에서 최종 진단이 애매한 경우에 부가적인 검사로 사용될 수 있으리라고 생각된다.

- 1052 -