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Variability in Penile Duplex Ultrasound International Practice Patterns, Technique and Interpretation: An anonymous survey of ISSM members

Penile duplex ultrasound (PDU), combined with pharmacologic stimulation of erection, is the gold standard for evaluation of multiple penile conditions. A 30-question electronic survey was distributed to members of the International Society for Sexual Medicine (ISSM). The survey assessed variability...

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Autores principales: Butaney, Mohit, Thirumavalavan, Nannan, Hockenberry, Mark S., Kirby, E. Will, Pastuszak, Alexander W., Lipshultz, Larry I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173975/
https://www.ncbi.nlm.nih.gov/pubmed/30108336
http://dx.doi.org/10.1038/s41443-018-0061-3
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author Butaney, Mohit
Thirumavalavan, Nannan
Hockenberry, Mark S.
Kirby, E. Will
Pastuszak, Alexander W.
Lipshultz, Larry I.
author_facet Butaney, Mohit
Thirumavalavan, Nannan
Hockenberry, Mark S.
Kirby, E. Will
Pastuszak, Alexander W.
Lipshultz, Larry I.
author_sort Butaney, Mohit
collection PubMed
description Penile duplex ultrasound (PDU), combined with pharmacologic stimulation of erection, is the gold standard for evaluation of multiple penile conditions. A 30-question electronic survey was distributed to members of the International Society for Sexual Medicine (ISSM). The survey assessed variability in current PDU practice patterns, technique and interpretation. Chi-square test was used to determine association between categorical variables. Approximately 9.5% of all 1,996 current ISSM members completed the survey. Almost 80% of members surveyed reported using PDU, with more North American practitioners utilizing PDU than their European counterparts (94% vs. 69%, p < 0.01). Approximately 62% of PDU studies were performed by a urologist and more than 76% were interpreted by a urologist. Although almost 90% of practitioners reported using their own protocol, extreme variation in technique existed among respondents. Over 10 different pharmacologic mixtures were used to generate erections, and 17% of respondents did not repeat dosing for insufficient erection. Urologists personally performing PDU were more likely to assess cavernosal artery flow using recommended techniques with the probe at the proximal penile shaft (73% vs 40%) and at a 60-degree angle or less (68% vs 36%) compared to non-urologists (p < 0.01). Large differences in PDU diagnostic thresholds were apparent. Only 38% of respondents defined arterial insufficiency with a peak systolic velocity < 25 cm/sec, while 53% of respondents defined venous occlusive disease with an end diastolic velocity > 5 cm/sec. This is the first study to assess variability in PDU protocol and practice patterns and to pinpoint areas of improvement. As in other surveys, recall bias, generalizability, and response rate (9.5%) are inherent limitations to this study. Although most respondents report utilizing a standardized PDU protocol, widespread variation exists among practitioners in terms of both technique and interpretation, limiting accurate diagnosis and appropriate treatment of penile conditions.
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spelling pubmed-61739752019-02-14 Variability in Penile Duplex Ultrasound International Practice Patterns, Technique and Interpretation: An anonymous survey of ISSM members Butaney, Mohit Thirumavalavan, Nannan Hockenberry, Mark S. Kirby, E. Will Pastuszak, Alexander W. Lipshultz, Larry I. Int J Impot Res Article Penile duplex ultrasound (PDU), combined with pharmacologic stimulation of erection, is the gold standard for evaluation of multiple penile conditions. A 30-question electronic survey was distributed to members of the International Society for Sexual Medicine (ISSM). The survey assessed variability in current PDU practice patterns, technique and interpretation. Chi-square test was used to determine association between categorical variables. Approximately 9.5% of all 1,996 current ISSM members completed the survey. Almost 80% of members surveyed reported using PDU, with more North American practitioners utilizing PDU than their European counterparts (94% vs. 69%, p < 0.01). Approximately 62% of PDU studies were performed by a urologist and more than 76% were interpreted by a urologist. Although almost 90% of practitioners reported using their own protocol, extreme variation in technique existed among respondents. Over 10 different pharmacologic mixtures were used to generate erections, and 17% of respondents did not repeat dosing for insufficient erection. Urologists personally performing PDU were more likely to assess cavernosal artery flow using recommended techniques with the probe at the proximal penile shaft (73% vs 40%) and at a 60-degree angle or less (68% vs 36%) compared to non-urologists (p < 0.01). Large differences in PDU diagnostic thresholds were apparent. Only 38% of respondents defined arterial insufficiency with a peak systolic velocity < 25 cm/sec, while 53% of respondents defined venous occlusive disease with an end diastolic velocity > 5 cm/sec. This is the first study to assess variability in PDU protocol and practice patterns and to pinpoint areas of improvement. As in other surveys, recall bias, generalizability, and response rate (9.5%) are inherent limitations to this study. Although most respondents report utilizing a standardized PDU protocol, widespread variation exists among practitioners in terms of both technique and interpretation, limiting accurate diagnosis and appropriate treatment of penile conditions. 2018-08-14 2018-10 /pmc/articles/PMC6173975/ /pubmed/30108336 http://dx.doi.org/10.1038/s41443-018-0061-3 Text en Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use: http://www.nature.com/authors/editorial_policies/license.html#terms
spellingShingle Article
Butaney, Mohit
Thirumavalavan, Nannan
Hockenberry, Mark S.
Kirby, E. Will
Pastuszak, Alexander W.
Lipshultz, Larry I.
Variability in Penile Duplex Ultrasound International Practice Patterns, Technique and Interpretation: An anonymous survey of ISSM members
title Variability in Penile Duplex Ultrasound International Practice Patterns, Technique and Interpretation: An anonymous survey of ISSM members
title_full Variability in Penile Duplex Ultrasound International Practice Patterns, Technique and Interpretation: An anonymous survey of ISSM members
title_fullStr Variability in Penile Duplex Ultrasound International Practice Patterns, Technique and Interpretation: An anonymous survey of ISSM members
title_full_unstemmed Variability in Penile Duplex Ultrasound International Practice Patterns, Technique and Interpretation: An anonymous survey of ISSM members
title_short Variability in Penile Duplex Ultrasound International Practice Patterns, Technique and Interpretation: An anonymous survey of ISSM members
title_sort variability in penile duplex ultrasound international practice patterns, technique and interpretation: an anonymous survey of issm members
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173975/
https://www.ncbi.nlm.nih.gov/pubmed/30108336
http://dx.doi.org/10.1038/s41443-018-0061-3
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