Ultrasound evaluation of the penis

Ultrasound is an excellent method for the study of penis. In this article, using a critical review of the literature and teaching files, we present examples of the major findings in the ultrasound routine, focusing on trauma, priapism, Peyronie's disease, and erectile dysfunction.

Keywords:
Penis; Ultrasonography; Ultrasonography, Doppler, color; Ultrasonography, Doppler, duplex; Penile diseases

Authorship

Maitê Aline Vieira Fernandes

MD, Radiologist, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.Universidade Federal do Triângulo MineiroBrazilUberaba, MG, BrazilMD, Radiologist, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.

Luis Ronan Marquez Ferreira de Souza Mailing address: Dr. Luis Ronan Marquez Ferreira de Souza. Avenida Claricinda Alves de Resende, 1650, L9Q9, Flamboyant Residencial Park. Uberaba, MG, Brazil, 38081-793. E-mail: luisronan@gmail.com.

MD, Radiologist, Associate Professor in the Department of Radiology and Diagnostic Imaging of the Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.Universidade Federal do Triângulo MineiroBrazilUberaba, MG, BrazilMD, Radiologist, Associate Professor in the Department of Radiology and Diagnostic Imaging of the Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.

Luciano Pousa Cartafina

MD, Urologist, Member of the Clinical Staff of the Urology Department of the Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.Universidade Federal do Triângulo MineiroBrazilUberaba, MG, BrazilMD, Urologist, Member of the Clinical Staff of the Urology Department of the Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil.

Mailing address: Dr. Luis Ronan Marquez Ferreira de Souza. Avenida Claricinda Alves de Resende, 1650, L9Q9, Flamboyant Residencial Park. Uberaba, MG, Brazil, 38081-793. E-mail: luisronan@gmail.com.

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Figures

Figures (10)

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Figure 1
Normal penile anatomy, ventral and cross-sectional views showing two hypoechoic images corresponding to the corpora cavernosa (two-headed arrow), with their respective cavernous arteries (thick arrows), with an echoic line that surrounds them and corresponds to the tunica albuginea (thin arrow). Note the corpus spongiosum (asterisk) adjacent to the corpora cavernosa.

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Figure 2
Longitudinal section of the penis under right lateral access. Note the cylindrical structure, corresponding to the corpus cavernosum (thick arrow), in the superior portion and the corpus spongiosum (thin arrow), adjacent to the corpus cavernosum, in the inferior portion.

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Figure 3
Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Normal flow pattern of the cavernous artery in a flaccid penis.

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Figure 4
A: Ultrasound of the penis, right lateral view. Longitudinal section showing rupture of the tunica albuginea with an adjacent 1.92 cm hematoma (between calipers), due to trauma. B: Axial T2-weighted turbo spin-echo magnetic resonance imaging scan showing left-sided discontinuity of the tunica albuginea (arrow), secondary to fracture.

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Figure 5
Color Doppler ultrasound demonstrating a hypoechoic collection that corresponds to hematoma with arteriovenous fistula secondary to traumatic injury of the penis due to impact with bicycle handlebars, resulting in high-flow priapism.

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Figure 6
Transverse ultrasound of the penis, in a ventral view, in the middle portion of the penis. Note the echoic image with posterior acoustic shadowing, corresponding to calcification (arrow), in the left corpus cavernosum.

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Figure 7
Conventional X-ray, penetrating the soft parts of the penis, showing radiopaque images that correspond to calcifications in the corpora cavernosa (arrows).

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Figure 8
Transverse ultrasound image, ventral view of the penis. Image obtained after induction of an erection, 15 min after injection of prostaglandin E1, showing dilated sinusoids (arrows).

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Figure 9
Graphs representing the color Doppler spectrum of the flow pattern of the cavernous arteries during the erection phases. A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic and diastolic flow 10 min after vasoactive drug injection. C: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin.

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Figure 10
Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection (A, B, and C, respectively). Note that the cavernous artery flow remains below the expected levels (at least 25-35 cm/s), which indicates erectile dysfunction due to arterial insufficiency.

Figure 1 Normal penile anatomy, ventral and cross-sectional views showing two hypoechoic images corresponding to the corpora cavernosa (two-headed arrow), with their respective cavernous arteries (thick arrows), with an echoic line that surrounds them and corresponds to the tunica albuginea (thin arrow). Note the corpus spongiosum (asterisk) adjacent to the corpora cavernosa.

Figure 2 Longitudinal section of the penis under right lateral access. Note the cylindrical structure, corresponding to the corpus cavernosum (thick arrow), in the superior portion and the corpus spongiosum (thin arrow), adjacent to the corpus cavernosum, in the inferior portion.

Figure 3 Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Normal flow pattern of the cavernous artery in a flaccid penis.

Figure 4 A: Ultrasound of the penis, right lateral view. Longitudinal section showing rupture of the tunica albuginea with an adjacent 1.92 cm hematoma (between calipers), due to trauma. B: Axial T2-weighted turbo spin-echo magnetic resonance imaging scan showing left-sided discontinuity of the tunica albuginea (arrow), secondary to fracture.

Figure 5 Color Doppler ultrasound demonstrating a hypoechoic collection that corresponds to hematoma with arteriovenous fistula secondary to traumatic injury of the penis due to impact with bicycle handlebars, resulting in high-flow priapism.

Figure 6 Transverse ultrasound of the penis, in a ventral view, in the middle portion of the penis. Note the echoic image with posterior acoustic shadowing, corresponding to calcification (arrow), in the left corpus cavernosum.

Figure 7 Conventional X-ray, penetrating the soft parts of the penis, showing radiopaque images that correspond to calcifications in the corpora cavernosa (arrows).

Figure 8 Transverse ultrasound image, ventral view of the penis. Image obtained after induction of an erection, 15 min after injection of prostaglandin E1, showing dilated sinusoids (arrows).

Figure 9 Graphs representing the color Doppler spectrum of the flow pattern of the cavernous arteries during the erection phases. A: Single-phase flow with minimal or absent diastole when the penis is flaccid. B: Increased systolic and diastolic flow 10 min after vasoactive drug injection. C: Increased systolic flow and reverse diastole 25 min after injection of prostaglandin.

Figure 10 Longitudinal, ventral ultrasound of the penis, with pulsed mode and color Doppler. Flow of the cavernous arteries at 5, 15, and 25 min after prostaglandin injection (A, B, and C, respectively). Note that the cavernous artery flow remains below the expected levels (at least 25-35 cm/s), which indicates erectile dysfunction due to arterial insufficiency.

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Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

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Ultrasound evaluation of the penis

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[1] Mailing address: Dr. Luis Ronan Marquez Ferreira de Souza. Avenida Claricinda Alves de Resende, 1650, L9Q9, Flamboyant Residencial Park. Uberaba, MG, Brazil, 38081-793. E-mail: luisronan@gmail.com.