(248) GRAYSCALE ULTRASOUND ASSESSMENT OF PATIENTS WITH ERECTILE DYSFUNCTION FROM CRURAL FIBROSIS SECONDARY TO BLUNT PERINEAL TRAUMA OR PELVIC FRACTURE
Authors: Weinberger J , Kim NN , Goldstein SW , Goldstein I 
Published: December 2024

Abstract

Introduction
In individuals with ED, grayscale imaging during B-mode ultrasound (GUS) of the erect penis in the presence of maximal smooth muscle relaxation has been utilized to measure corpora cavernosal (CC) fibrosis. CC fibrosis, with excess connective tissue and reduced smooth muscle content, may occur in ED secondary to atherosclerotic vascular disease, resulting in poor tissue expandability and corporal veno-occlusive dysfunction. GUS images of such individuals reveal multiple hypoechoic, inhomogeneous areas within all regions of the CC, consistent with diffuse CC fibrosis. In contrast, GUS imaging in individuals without ED under similar conditions of maximal smooth muscle relaxation reveals normoechoic, homogenous areas within all regions of the corpora cavernosa. Bertolotto et al reported an ED case in which the GUS revealed both homogeneity and inhomogeneity in the same patient in different locations of the CC. Focal trauma to the perineum from bicycle riding resulted in significant localized crural CC inhomogeneity, consistent with crural CC fibrosis, while GUS of the uninjured penile shaft revealed penile shaft CC homogeneity.

Objective
To assess both crural and penile shaft CC homogeneity/inhomogeneity by GUS in a cohort of patients with ED from blunt perineal trauma or pelvic fracture.

Methods
A retrospective chart review was performed of ED patients who met the following inclusion/exclusion criteria: ≤45 years old, history of blunt perineal trauma/pelvic fracture resulting in ED, ≤1 atherosclerotic vascular risk factor exposure, IIEF completed, and GUS of the crura and penile shaft completed. GUS was performed usig a high frequency probe (15.4 mHz) during pharmacologic erection (EHS grade 3-4/4) in the proximal, midportion, and distal penile shaft as well as right and left crura at various B-mode intensities (45%-65%) and dynamic ranges (49-70 dB). A visual grading score was utilized to assess for GUS homogeneity/inhomogeneity: Grade 0 for &lt;10% hypoechoic area, Grade 1 for ≥10% to &lt;25% hypoechoic area, Grade 2 ≥ 25% to &lt;50% hypoechoic area, and Grade 3 ≥ 50% hypoechoic area.

Results
A total of 22 patients formed the study cohort (mean age 29 ± 11 years). Bicycle or dirt bike riding was reported in 64%, other straddle injuries in 23%, and pelvic fracture in 13%. Mean IIEF-EF domain score was 15 ± 8. No patient in this cohort had hypertension, hyperlipidemia, heart disease, or diabetes; 25% had current/past cigarette smoking. Mean GUS visual grading scores for the crural region was 2.2 ± 0.4, consistent with right/left crural CC fibrosis. Mean GUS visual scores for the proximal, mid-portion, and distal penile shaft were 0.8 ± 0.1, 0.5 ± 0.1 and 0.6 ± 0.1, respectively, consistent with penile shaft CC homogeneity (Fig. 1).

Conclusions
GUS is a non-invasive imaging strategy for patients with blunt perineal trauma/pelvic fracture-related ED that can be successfully utilized to better understand the underlying ED pathophysiology. In these patients, GUS reveals a signature finding of both crural CC inhomogeneity, consistent with crural fibrosis, and concomitant penile shaft CC homogeneity, consistent with no fibrosis in the uninjured penile shaft.

Disclosure
No.