PENILE ULTRASOUNDNot It!

Jenelle Beadle2/1/2016

Segmental Anatomy

Orientation

Prox

Dist

Orientation

Dorsal

Ventral

Cavernosa = DorsalSpongiosum = Ventral

Psst! It’s pronounced alb-you-jin-ee-uh

Fascial Layers

Tunica Albuginea Thickness• Flacid: 1-2 mm• Erect: 0.25-0.5mm

Tunica Albuginea Thickness• Flacid: 1-2 mm• Erect: 0.25-0.5mm

Tunica Albuginea Thickness• Flacid: 1-2 mm• Erect: 0.25-0.5mm

MRI• better visualization of

anatomy

Ultrasound• cheaper• evaluate blood flow with

Doppler

Acute Indications & Findings

Trauma Pain Erection

Fracture X XLow Flow Priapism X XHigh Flow Priapism X X

PriapismLOW FLOW PRIAPISM(ISCHEMIC)

HIGH FLOW PRIAPISM(NON-ISCHEMIC)

outflow obstruction idiopathic drug related

more common sustained rigid erection

(glans spared) painful emergency

stagnation leads to ischemic corpora

often presents within hours

increased inflow AV fistula (trauma) no outflow obstruction

less common sustained partial

erection painless non-emergent

well oxygenated corpora

may take days to weeks to present

Penile Fracture Tear in the tunica albuginea

disrupted tunica with associated hematoma hx of trauma immediate detumescence painful swelling discoloration

Penile Fracture

Long

Trans

Penile Fracture

Long

Trans

C

C S

Penile Fracture

LongTrans

Penile Fracture

LongTrans

C

CS

Penile Fracture - MRI

Penile Fracture - MRI

Chronic Indications palpable abnormality focal tenderness abnormal curvature

Chronic Indications palpable abnormality focal tenderness abnormal curvature

Most common finding:Peyronie’s Disease

Peyronie’s Disease Cause is not

completely understood trauma, meds, diabetes

Scarring of the tunica albuginea dorsal (most common),

ventral and septal originates immediately

deep to the tunica albuginea

Ultrasound Findings Focal thickening

typically linear and calcified with shadowing echogenic, isoechoic, hypoechoic

Scarring is not elastic• Results in

curvature during erection

• towards the defect

Honorable Mention: Mondor Disease

Thrombophlebitis of the superficial dorsal vein cord-like palpable

abnormality painful

Self limiting treated like any other

superficial thrombophlebitis warm compress Anticoagulants

Same name when it occurs in the chest wall

Scanning Protocol No written protocol Scheduled as an extremity with rad time

ER and outpatient we do not schedule these for erectile

dysfunction Any sonographer expected to scan Any body radiologist expected to read

radiologist must be given the opportunity to scan

Most important structure to evaluate is the tunica albuginea must be examined from multiple approaches

• Dorsal • Parasagittal

• Ventral • Parasagittal &

Midline• Coronal

• Rt & Lt Lateral

Ultrasound examination requires multiple approaches:

Ultrasound examination requires multiple approaches:

• Dorsal • Parasagittal

• Ventral • Parasagittal &

Midline• Coronal

• Rt & Lt Lateral

Ultrasound examination requires multiple approaches:

• Dorsal • Parasagittal

• Ventral • Parasagittal &

Midline• Coronal

• Rt & Lt Lateral

Suggested Protocol Dorsal (3 images, 1 cine)

Long Rt & Lt Cavernosum Trans Cavernosa Trans Dorsal Cine Prox-Dist

Coronal – Rt & Lt (2 images) Long Lateral Rt Cavernosum Long Lateral Lt Cavernosum

Ventral (2 images, 1 cine) Long Spongiosum Trans Spongiosum Trans Ventral Cine Prox-Dist

Area of concern Additional images as necessary to evaluate

pathology be as specific as possible when describing location