title: Penile Doppler ultrasound in men with stuttering priapism and sickle cell disease -- a labile baseline diastolic velocity is a characteristic finding.
abstract: BACKGROUND
  Stuttering priapism (SP) is seen in sickle cell disease (SCD) and characterized by short-lived painful erections. Imbalanced vascular tone is the postulated cause and this may be reflected in changes in baseline penile blood flow as measured using penile Doppler ultrasound (PDU).
  
  
  OBJECTIVE
  The aim of this study was to investigate the baseline penile blood flow characteristics in men with SCD and SP, by comparing with men without SP.
  
  
  METHODS
  PDU findings were retrospectively analyzed in 100 men during flaccid state. Nine men had SP (age range 20-40 years), 4 had Peyronie's disease (PD) (35-48 years), 67 men had erectile dysfunction (16-67 years), and 20 men had normal erectile function (18-42 years).
  
  
  METHODS
  The variables measured were peak systolic and end-diastolic velocities, and the Doppler velocity waveform. Values in men with SP were compared with those in the other groups.
  
  
  RESULTS
  Median systolic and diastolic velocity was significantly higher in men with SP (systolic/diastolic velocity was 26/4 cm/second in men with SP vs. 13/0 cm/second, 14/0 cm/second, and 16/0 cm/second in men with PD, ED, and normal erectile function, respectively; P=0.0001). Men with SP had a characteristic low peripheral resistance (PR) waveform with fluctuating velocities; the diastolic velocity was consistently positive (2-7 cm/second) and fluctuated between +2 and +8 cm/second. In comparison, the other 91 men had high PR waveform and consistently negative diastolic velocity (range 0 to -2 cm/second).
  
  
  CONCLUSIONS
  Men with SP had a unique baseline Doppler ultrasound waveform, with a low PR waveform and an elevated, variable cavernosal artery velocity. We propose that this may be the sonographic manifestation of a reduced, fluctuating smooth muscle tone and that PDU may have a role for diagnosis and therapeutic monitoring of SP.
authors.affiliation: Department of Radiology, St George's Hospital and Medical School, London, UK.
authors.forename: Uday
authors.initials: U
authors.lastname: Patel
authors.forename: Arunan
authors.initials: A
authors.lastname: Sujenthiran
authors.forename: Nick
authors.initials: N
authors.lastname: Watkin
mesh_terms: D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000150:complications / Q000503:physiopathology*; D001783:Blood Flow Velocity; D006801:Humans; D008297:Male; D008875:Middle Aged; D010411:Penile Induration / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010413:Penis / Q000098:blood supply* / Q000000981:diagnostic imaging; D011317:Priapism / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D018616:Ultrasonography, Doppler, Duplex
keywords: Penile Doppler; Sickle Cell Disease; Stuttering Priapism; Ultrasound