Doppler ultrasound report

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lonelyboy

Hi All,
I've got my Doppler report from a while back and I would like to have opinions on what it indicates, I will be trying to figure it out but any hints to get me going in the right direction would be gratefully recieved.
(free ultrasound online course by futurelearn - thanks Welshwales)
Many thanks.

Quote
Ultrasound (US) Doppler Penis
Indication ED. ?Peyronies disease
20micrograms of Viridal injected in the right corpus Cavernosum. No calcified plaques seen. Sub-oplimal tumescence (40%) with just about normal peak systolic velocities. High end-diastolic flow seen but there was intermittent absent end-diastolic flow noted. The DDV flow measured 4-10mm during course of the scan
Rt. CC peak systolic velocity = 47cm/s
Lt.CC peak systolic velocity = 39cm/s
DDV peak velocity = 4-10cm/s

Pfract

Hello. Here is the reports of my doppler, so you can compare.

QuoteDuplex Doppler ultrasonography was performed during pharmacologic erection. The patient was injected with 0.20 ml of the vasoactive agent 30-2-20. Gray scale studies showed mild left corporal fibrosis and mild right corporal fibrosis.
The tunical thickness was 1.5 mm (dorsal) and 1.2 mm (ventral).
The septal thickness was 1.1 mm.
The right cavernosal artery grade was 1 out of 3 with no atherosclerosis. The diameter of the right cavernosal artery was 1.0 mm.
The left cavernosal artery grade was 1 out of 3 with no atherosclerosis. The diameter of the left cavernosal artery was 1.3 mm.
Duplex Doppler ultrasound studies showed that the right cavernosal artery peak systolic velocity values were 30.9 and 39.73 cm/s with end-diastolic velocity values of 0 and 0 cm/s, respectively.
The left cavernosal artery peak systolic velocity values were 23.41 and 40 cm/s with end-diastolic velocity values of 0 and 0 cm/s, respectively.
This hemodynamic test revealed abnormal Gray scale findings including mild corporal fibrosis,
This test also revealed abnormal duplex Doppler findings, with reduced peak systolic velocity values for his age and no end diastolic velocity values in the presence of pharmacologic smoth muscle relaxation.

I had a grade 4 erection with no venous leak, when i had the erection shot. We can compare both values for arterie inflow. I fractured my penis, so my arteries are blocked. I think your test indicates that you have a slight venous leak, but i am not sure?

lonelyboy

Wow, yours is so much more detailed, I still can't see it myself but you're on the money with the venous leak.
Thanks for this I'll digest it over a few days.

Pfract

Yes... looks like it because the doctor told me i have "no venous leak", and indeed i had an erection in office for close to 1 hour, if not more and it never went down, not to mention i took 4 shots of phenilephrine to bring it down. DAMN IT!

So... i have "no end diastolic velocity", for no venous leak. whilst yours says different. But hey, people can overcome a minor venous leak with injections or pills, so there is hope and you have to try what works best for you.

lonelyboy

Thanks, I'm getting poorer results from the pills and I haven't responded well to the three times I've had the injections for tests.
I've been offered venous ligation and I'm just making sure nothing has been missed (I'm a bit of a control freak) before accepting and hoping I'm one of the few that it works for.
I'm not finding much to explain ultrasound so may have to accept that they're doing the best they can  ;)
Really appreciate the help.

lonelyboy


Pfract

You should check the literature on Venous ligation surgeries. Based on what i read on pubmed, as long as it is a very, very specific leak, you will be wasting your time. The majority of doctors today, recommends the implant for serious venous leakage.

Obviously you can try whatever you want, but.... Oh, and thanks for the link above. It comes from a reputable doctor, Dr. Laurence Levine. By the way, have you read the "contemporary review of the literature on peyronies disease by him?"

Awesome paper on peyronies, from Fev/2016!

skunkworks

I would suggest reading up on vein embolisation by an interventional radiologist as a potential treatment for your venous leakage. It is the superior procedure in my opinion, but not very well known, possibly because it is not performed by the urologist so there is no money in it for them.

Much safer operation as well, no incision into the penis, no implant etc.  
This is an emotionally destructive condition, we all have it, let's be nice to each other.

Review of current treatment options by Levine and Sherer]

lonelyboy

Hi Pfract.
I have a strong reluctance to going the implant route just yet, we kind of get by with what I've got left, besides I think I would only be offered the 1 piece rather than the 3 as its less risk of infection and I'm immune compromised.
I thought it worth a try as from my reading on the subject it shouldn't compromise future attempts at fixing (just been reading ESWT and ED Penile Low Intensity Shock Wave Treatment is Able to Shift PDE5i Nonresponders to Responders: A Double-Blind, Sham Controlled Study. - PubMed - NCBI) and it also seems that I need to get the leakage fixed before I can get anyone to believe I have a bend  :(
I have read a paper by him but the one I have is from 2013, I'll have another look later, I have read several (not in depth though) papers and to quote someone else on the forum "I now know more about the penis than I ever wanted to"

I think the leak is fairly specific, I had a cavernosogram done below by Dr Alex Kirkham (this is his paper on MRI MRI of the penis)

QuoteCavernosogram
20mcg of caverject produced only poor tumescence; we started the test after 11min, when the intracavernosal pressure had only risen by 10cm water. Infusion at up to 50ml/min did not produce full tumescence or pressures over 55cm water, and there was a rapid decline in pressure on stopping it: positive for 'leak'. There was some opacification of crural veins, but the most prominent drainage was via a vein extending from the dorsal vein at the base of the pendulous part to the right (see the images). The finding that mainly the R sided pelvic veins opacify supports this as a significant route of drainage. We should discuss in the MDT

@Skunkworks, I have read on the subject but haven't found much other than a private hospital in London that does it, I will mail the dr above and ask if the procedure is done over here on the NHS, I can't afford to do anything privately though.

Thanks for pointers and suggestions.

Pfract

I understand, but let me tell you that fortunately for you, you are wrong. And i actually know of a patient from the states, who did is implant with a 3 piece and is also immune compromised. The outcome was not very good, but it was because of the doctor itself, and not the immune system condition.

I am  not going to bash skunkworks, because the procedure is available at certain places; but if you read reports of patients that had it done, and read the literature on it, you will see that it has marginal success at best and in most cases the leak comes back. You will be putting yourself through a procedure only to having it fail at a later date, almost for sure. Don't you think that if the procedure was super successful that lot's of clinics wouldn't have it? And... if you financially have the possibility, come to the US for diagnostics. 1500GBP/2000GBP i would say would be ok for going to san diego, to a clinic specialized in Sexual Medicine, with a top Us doctor.

skunkworks

[Long-term results of the veno-occlusive percutaneous treatment of erectile disorders of venous origin]. - PubMed - NCBI

QuoteUp to now, 11 patients over 15 (73.4%) refer a good improvement of erectile dysfunction together with a satisfactory sexual activity.

That is not much lower than the 89% success rate for implants.

And the other study was about 55% long term success on follow up, I cannot find it right now. Needless to say the results are comparable or better than ligation, without making an incision on the penis. And from an anecdotal perspective, I personally know 2 people who had it done with good long term success.

And here is a report of success with the procedure:

https://www.thundersplace.org/progress-reports-and-pictures/before-and-after-surgery-2.html#post2008192

The thing that people miss when they look into embolisation is that the procedure is so non damaging that you can just go get it done again with zero issues if it does not completely cure the issue. There is no big incision on the penis, there is essentially zero damage and zero risk, with the obvious exception of human error. The I guess expense is a risk, if it comes back and you have to have it again.

I do not know why it is not more well known or offered in more places, but it is definitely not because of success rates otherwise ligation would never be offered to anyone. Here in Australia it is offered everywhere there is an interventional radiology department, you just need to know to ask about it.
This is an emotionally destructive condition, we all have it, let's be nice to each other.

Review of current treatment options by Levine and Sherer]

Pfract

Skunkworks: with all honesty, you do realize that the percentage is super low right? Not to mention the study is quite old, and it was posted on a not reputable urology journal. You do know that, don't you? You cannot go online and just "cherry pick" information because you found it, and state that is "the de facto truth" because it's online.

Not saying that it is just you, but what i find most sad about it, is that people don't try to use the current medical guidelines, nor the information from the most reputable sources, where you can find the gerenal medical consensus. This goes for ED, and Peyronies.

Dude.. i am not making fun of you, but yo are referring thundersplace? a penis enlargement website? where users "believe their penis gets tired after masturbating several times" and that "you can bend your penis without fracturing it" and they say stuff like "i bent my penis half erect, so you should too".... ? serious?

Think about it... I said this before: Laurence levine release less than 4 months ago the best we can possibly have in what concerns ALL OF THE BEST TREATMENTS CURRENTLY FOR PEYRONIES DISEASE. And you know what? more than half of this community does not give a single F U C K !  :-X

skunkworks

I'm sorry but none of that post is a valid rebuttal. Nor is a rebuttal even needed. Nothing was cherry picked, those are the studies available. The fact that the person reporting success was on thundersplace does nothing to change that it was a successful case study, with pictures of improvement.

He will read the evidence and pick the treatment he wants. I feel I have a responsibility to make him aware of all the options and I have done so.

73.4% success rate would not be seen as 'super low' by any reasonable person. Nor does it make any sense to call the Archives of Italian Urology and Andrology a 'not reputable urology journal', it has been in publication since 1924!

You might have noticed I link to Levine's paper in my signature.

You seem to have some personal issue with this and/or me, please leave it at the door.
This is an emotionally destructive condition, we all have it, let's be nice to each other.

Review of current treatment options by Levine and Sherer]

Pfract

Actually i don't Skunkworks, and i apologize for coming across as offensive towards you. I really don't have anything against, (as like a personal crusade) you. Just that i get sort of disappointed with the "whole diagnosing my ED situation path most people take" that's all. Yes, everybody should do what they please, and address their situation the way they feel most appropriate. But.... :|

What i meant was, that although the success rate is high, the control group is small and there was no more papers on that? Please correct me if i am wrong.

As for the levine paper, yes you do care. That is awesome! But i feel overwhelmed about that. Shouldn't we use that paper to direct the new members and refine "the advice given to posters here" based on that? Maybe i couldn't see it properly, but i don't feel like that was what happened, in general. Again, please correct me if i am wrong.

And also, i am going offtopic with this last post, so maybe thread split if you find advisable?

james1947

skunkworks

Please don't take pfract seriously :)
He like to get in quarrel with people, especially if they are not ready to accept his ideas and position :D

James
 
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

lonelyboy

Just as an update and a thanks to skunkworks, I've finally got agreement to have embolism using interventional radiology rather than surgical ligation  :D yay, it did take a bit of phoning around talking to people, emailing, more phoning, more emails, clinic visits and finally some insistence in the face of refusal (which is very unusual for me).

Pfract, I do take on board that it may not work for long or even at all but I think its worth the try, I do appreciate the discussion though.

I'll update the board as I progress.