Ecografie — Penis (MCB)

PENIS US PROTOCOL

PURPOSE:

 To evaluate the penis for structural and vascular anomalies.

INDICATIONS:

 Evaluation of intactness of the tunica albuginea in the setting of trauma  Evaluation of palpable abnormalities including fracture, tumor, hematoma & cavernosal herniation  Evaluation of penile plaques/fibrosis in the setting of Peyronie’s disease  Evaluation of arterial and venous blood flow  Evaluation of the urethra for diverticula, abscess, stricture and calculi  We do not perform post pharmacostimulation imaging

EQUIPMENT:

 6-18 MHz high-resolution small-footprint probe

PATIENT PREPARATION & ASSESSMENT:

 Introduce yourself to the patient.
 Verify patient identity via two patient identifiers (name and date of birth) per hospital policy.  Explain the examination, its purpose and how long it will take.  Answer any questions the patient may have regarding the examination.  Obtain patient history including symptoms, signs, risk factors and other relevant history.

GENERAL GUIDELINES:

 Have the patient lie supine with his legs together.  Use ample ultrasound gel so as not to compress structures.  Send the measurements screenshot page if your machine is capable.  For focal lesions (plaques, masses, hematomas) obtain split-screen images of the lesion without calibers, with calibers and with Color Doppler.
 Optimize equipment gain and display settings with respect to depth, dynamic range and focal zones while imaging vessels.  Add color Doppler to supplement grayscale images with proper color scale to demonstrate areas of high flow and color aliasing.  Use power Doppler to validate low flow states or occlusions.  Set spectral Doppler gains to allow a spectral window and optimized to reduce artifacts.  Cursor sample size will be small and positioned parallel to the vessel wall and/or direction of blood flow.  A spectral Doppler angle of 45-60 degrees or less will be used to measure velocities. Note exceptions to these angles on the technologist worksheet.  Any deviations from the standard protocol and any limitations to the examination should be documented on the technologist worksheet for future reference and for repeatability in follow-up studies.  Report preliminary critical findings to the referring clinician when appropriate (i.e. immediate medical attention may be warranted) and according to hospital policy.

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DOCUMENTATION:

Grayscale  If machine is capable, obtain a cine clip of the penis in the dorsal transverse plane scanning from base to tip.
 Document dorsal transverse images of the base, mid and tip aspects of the penis.  Document ventral (urethral) images of the base, mid and tip aspects of the penis.  Document dorsal longitudinal images through the right corpus cavernosa sweeping lateral to medial.  Document dorsal longitudinal images through the left corpus cavernosa sweeping lateral to medial.

Color & Spectral Doppler  Obtain dorsal longitudinal images of the right corpus cavernosa without and with Color Doppler.  Obtain a dorsal longitudinal image of the right corpus cavernosa measuring the diameter of the cavernosal artery (normal diameter is 0.2-1.0 mm).  Obtain a dorsal longitudinal image of the right cavernosal artery measuring the PSV, EDV and RI (in the flaccid state PSV is 5-20 cm/sec, EDV is 0 cm/sec and RI is 1.0).  Repeat these 3 steps for the left corpus cavernosa and the cavernosal artery.  Obtain dorsal longitudinal images with Doppler flow in the mid plane of the penis to document patency of the superficial dorsal and deep dorsal veins.

ANATOMY:

 The dorsal aspect of the penis is the side with the two corpus cavernosa.  The ventral (urethral) aspect of the penis is the side with the single corpus spongiosum (containing the urethra).

REFERENCES:  Avery, L. L., & Scheinfeld, M. H. (2013). Imaging of PENILE and Scrotal Emergencies. RadioGraphics, 33(3), 721-740. doi:10.1148/rg.333125158.  Nicola, R., Carson, N., & Dogra, V. S. (2014). Imaging of traumatic injuries to the scrotum and penis. American Journal of Roentgenology, 202(6). doi:10.2214/ajr.13.11676.  Penile and perineal doppler ultrasound demonstration. Retrieved April 16, 2021, from https://www.youtube.com/watch?v=79t3SvINMNE.

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 Penile Ultrasound. Retrieved April 16, 2021, from https://russellgroupllc.org/wp- content/themes/bgmd/assets/presentations/PenileUltrasoundOct2010s.pdf.  Penile Ultrasound. Retrieved April 16, 2021, from https://radiologykey.com/penile-ultrasound/.

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