Ebook Practical urological ultrasound: Part 2
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Ebook Practical urological ultrasound: Part 2
Penile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2rectile dysfunction (ED) but also plays an important role by providing an anatomic and functional vascular assessment in a multitude of other conditions including Peyronie’s disease, high-flow priapism, penile fracture, penile urethral strictures, urethral stones, or diverticula, or masses involving Ebook Practical urological ultrasound: Part 2 deep tissues of the penis. As a component of the evaluation for ED, penile Doppler ultrasound (PDƯ) is performed to assess the quality of arterial blEbook Practical urological ultrasound: Part 2
ood flow and sufficiency of veno-occlusive mechanisms, both necessary for an adequate erection. More recently, this imaging modality is playing a centPenile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2[)U is also an essential component of the assessment of external genitalia in trauma situations where high-flow priapism or penile fracture is suspected. Penile ultrasound provides a readily available, minimally invasives. Rais-Bahrami, MDHofstra North Shore LU School of Medicine, The ArthurSmith In Ebook Practical urological ultrasound: Part 2stitute for Urology. New Hyde Park. NY. USAB.R. Gilbert. MD. PhDtS)Hofstra North Shore LU School of Medicine, The ArthurSmith Institute for Urology. 4Ebook Practical urological ultrasound: Part 2
50 Lakeville Road.Suite M4I. New Hyde Park. NY 11042, USA e-mail: bgilbert@gmail.comdiagnostic modality that evaluates both the structural anatomy andPenile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2h an ultrasound frequency of 7.5-18 MHz which allows for high resolution images of the penis and internal vascular structures. Color and spectral Doppler are essential elements of penile ultrasonography in addition to B-tnode ultrasound. 3D ultrasound is a developing technique that has the potential Ebook Practical urological ultrasound: Part 2 for better defining anatomic and vascular changes occurring with disease processes of the penis.When available, split screen visualization allows forEbook Practical urological ultrasound: Part 2
comparison of laterality very similar to scrotal ultrasound discussed earlier. This is very important in penile ultrasound, but more specifically in Penile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2le view for comparison of the right and left sides.Scanning TechniqueScanning technique, as with any ultrasound examination, is operator-dependent and hence may vary greatly. Nevertheless, it is essential forPF. Fulgham and B.R. Gilbert (eds.). Practical Urological Ultrasound. Cuưent Clinical Urolog Ebook Practical urological ultrasound: Part 2y. DOI 10.1007/978-1-59745-351-6.7. ©Springer Science+Business Media New York 2013111112$. Rais-Bahrami and B.R. Gilberteach practitioner to establishEbook Practical urological ultrasound: Part 2
a routine protocol to which they fastidiously adhere. This allows for data to be comparable across serial examinations of the same patient and betweePenile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2patients prior to beginning the study. A technique for patient preparation, routine survey scanning, and indication-specific scanning protocols for penile ultrasound is presented.Patient PreparationThe patient should lie comfortably on the examination table in a supine position with legs together pr Ebook Practical urological ultrasound: Part 2oviding support for the external genitalia. An alternative position is dorsal lithotomy with the penis lying on the anterior abdominal wall. RegardlesEbook Practical urological ultrasound: Part 2
s of the patient position preferred. the area of interest should remain undraped for the duration of the examination. Care should be taken to cover thPenile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2el should be used between the transducer probe and the surface of the penis to allow' uninterrupted transmission of sound waves, thus producing a high-quality image.Penile Ultrasound ProtocolAs with other ultrasound exams, penile ultrasound Uses specific scanning techniques and images targeting the Ebook Practical urological ultrasound: Part 2clinical indication prompting the study. Irrespective of the indication for penile ultrasound, routine scanning during penile ultrasound should includEbook Practical urological ultrasound: Part 2
e both transverse and longitudinal views of the penis by placing the transducer probe on the dorsal or ventral aspect of the penis. The technique presPenile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2he goal is to visualize the cross-sectional view of the two corpora cavernosa dorsally and the corpus spongiosum ventrally along the length of the penis from the base of the penile shaft to the glans penis.The corpora cavernosa appear dorsal ly. as two homogeneously hypoechoic circular structures, e Ebook Practical urological ultrasound: Part 2ach surrounded by a thin (usually less than 2 mm) hyperechoic layer representing the tunica albuginea (hat envelops the corpora. The corpus spongiosumEbook Practical urological ultrasound: Part 2
is a ventrally located circular structure with homogeneous echotexture, usually more echogenic than the corpora cavernosa 111. It is best visualized Penile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2ined while scanning. For routine anatomic scanning of the penis w ith ultrasound, all three corpora can be sufficiently viewed from a single dorsal approach to the penile shaft. A survey scan is first performed prior to obtaining static images at the proximal (base), midportion, and distal (tip) of Ebook Practical urological ultrasound: Part 2the corpora cavernosal bodies for documentation (Figs. 7.1, 7.2 and 7.3). The value of the survey scan cannot be over stated. It often provides the peEbook Practical urological ultrasound: Part 2
rspective that is necessary to assure absence of coexisting pathology. A careful survey scan of the phallus w ill identify abnormalities of the cavernPenile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2scan include one transverse view at the base of the penile shaft, one at the mid-shaft, and a third at the distal shaft just proximal to the corona of the glans penis (Fig. 7.1a, b). Each image should show transverse sections of all three corporal bodies. As noted in the labeled images, orientation Ebook Practical urological ultrasound: Part 2by convention is for the right corporal body to be on the left side of the display (as viewed by the sonographer) while the left corporal body is locaEbook Practical urological ultrasound: Part 2
ted on the right side of the display. Figure 7.2 demonstrates two mid-shaft views: one with the transducer on the dorsal phallus and the other with thPenile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2gh the base and mid-shaft of the penis. In this image, the transducer is on the dorsal penile surface and demonstrates the right and left corpora cavernosa (re and Ic) and urethra (u).I bl Survey scan with transverse views through the base and distal shaft regions of the penis. In this image the tra Ebook Practical urological ultrasound: Part 2nsducer is on the dorsal penile surface and demonstrates the right and left corpora cavernosa (re and 1c) and urethra (u)Fig. 7.2 Demonstrates two midEbook Practical urological ultrasound: Part 2
-shaft views. The /e/r-side image demonstrates the view with the transducer on the dorsal phallus ami the rig/tt-sidc image with the transduceron the Penile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with er Ebook Practical urological ultrasound: Part 2 right and left corporal bodies. Figure 7.3 demonstrates a dorsal approach with measurements of the cavernosal artery diameter. By convention, the orientation is constant, with the projection of the right corporal body on the left side of the display while the left corporal body is located on the ri Ebook Practical urological ultrasound: Part 2ght side of the display.Penile UltrasoundSoroush Rais-Bahrami and Bruce R. GilbertIntroductionPenile ultrasound is commonly used in the diagnostic workup of a patient with erGọi ngay
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