Penile Dynamic Duplex Ultrasonography

Review Article

Austin J Urol. 2016; 3(3): 1050.

Penile Dynamic Duplex Ultrasonography

Oliveira P*, Leitao T, Oliveira T, Martinho D and Lopes T

Department of Urology, Hospital Santa Maria, Portugal

*Corresponding author: Oliveira P, Department of Urology, Hospital Santa Maria, 1649-035 Lisbon, Portugal

Received: October 04, 2016; Accepted: November 18, 2016; Published: November 23, 2016


Ultrasonography of the penis has a well-established role in the study of penile pathology. Regarding penile anatomy, specific structures can be well identified such as the circular hyperechoic tunica albuginea or the cavernosal arteries with their parallel hyperechoic walls. A proper understanding of erection physiology, from the initial smooth muscle relaxation to the veno-occlusive mechanism at full erection, when evaluated with ultrasonography, specifically with Doppler mode, allows extrapolation of the physiological phases of erection to a spectral waveform displayed in the ultrasound screen allowing full evaluation of penile hemodynamics. A step-by-step, standardized Doppler evaluation from a flaccid state to a pharmacological induced erection represents a valuable tool in the diagnosis and management of several vascular disturbances such as erectile dysfunction, Peyronie´s disease, or Mondor´s disease. Ultrasonography is also invaluable in the correct evaluation of priapism and penile trauma.

Keywords: Penile; Doppler; Duplex; Ultrasonography




Ultrasound (US) is a well-established imaging technique in the investigation of penile pathology [1]. Grayscale US allows evaluation of penile normal and pathological structures, and when combined with color and spectral Doppler provides objective and reliable evaluation of penile vasculature [2] and hemodynamics, especially with the addition of a pharmacological stimulant to produce an erection [3]. This technique, called Penile Dynamic Duplex Ultrasonography (PDDU), although not mandatory in the era of highly effective orally active agents for the treatment of Erectile Dysfunction (ED), might be necessary in primary ED (not caused by organic disease or psychogenic disorder), young patients with a history of pelvic or perineal trauma, who could benefit from potentially curative vascular surgery, patients with penile deformities which might require surgical correction (e.g., Peyronie´s disease) and for medico-legal reasons [4,5].

PDDU is a time consuming technique that should be performed in a standardized way in order to achieve an accurate clinical diagnosis [5].

Penile Anatomy

The penis consists of three cylinders [2,6], two dorsal hypoechoic Corpora Cavernosa (CC) surrounded by the thick fibrous sheath of the tunica albuginea [7,8] and the ventral Corpus Spongiosum (CS) containing the urethra (Figure 1), often compressed and difficult to visualize optimally from the ventral aspect [9]. The corpora cavernosa consist of multiple smooth muscle and endothelial-lined sinusoids, which are capable of considerable volume expansion. The albuginea is a 2-layer tunica with outer longitudinal fibers and inner circular fibers visualized as a linear hyperechoic structure [9], generally less than 2 mm thick [6]. The inner layer constitutes the intracavernosal septum, which is generally complete proximally and becomes fenestrated along the dorsal aspect in the mid-distal part. This anatomy is advantageous, making an injection to just one of the corporal bodies, enough for vasoactive medication to circulate to the contralateral side [10]. The three corpora are surrounded by the more superficial Buck´s fascia.