Number №2, 2020 - page 50-57

Penile hemodynamics with intracavenosal injection of alprostadil before and after the course of perineal muscles strengthening exercises DOI: 10.29188/2222-8543-2020-12-2-50-57

For citation: Ivanov S.V., Ovchinnikov R.S., Alexandrov B.Yu., Marishin R.I., Kiryuschenkov G.P., Prudnikov N.D., Mitrohin V.M., Krasnov A.V., Ivanov S.S., Matvienko Yu.A., Pyatnitskiy I.A., Kharlamov E.Yu. Penile hemodynamics with intracavenosal injection of alprostadil before and after the course of perineal muscles strengthening exercises. Experimental and clinical urology 2020;(2):50-57
Ivanov C.S., Aleksandrov B.Yu., Ivanov S.V., Krasnov A.V., Marishin R.I., Matvienko Yu.A., Ovchinnikov R.S., Pyatnickiy I.A., Mitrohin V.M., Kiryuschenkov G.P., Prudnikov N. D., Harlamov E.Yu.
Information about authors:
  • Ivanov S.S. – Ph.D., Cardiologist at the Medical centre «RostAgroExport»; Assistant Professor at the Functional and radiation diagnostics department at the Faculty of continued medical education at PFUR; 
  • Aleksandrov B.Yu. – Physician at the Medical centre «RostAgroExport»
  • Ivanov S.V. – Dr.Sc., chief of the Functional diagnostics department at the National hospital centre of «Russian Railways» JSC. Professor at the Functional and radiation diagnostics department at the Faculty of continued medical education at PFUR
  • Krasnov A.V. – Ph.D., urologist at the Urology department at the National hospital centre of  «Russian Railways» JSC; ORCID 0000-0003-0535-8338 
  • Marishin R.I. – Physician at the Medical centre «RostAgroExport»
  • Matvienko Yu..A. – Deputy Head physician of the Medical centre «RostAgroExport»;  
  • Ovchinnikov R.S. – PhD., Deputy Head physician of the Medical centre «RostAgroExport»; 
  • Pyatnitskiy I.A. – Physician at the Medical centre «RostAgroExport»
  • Mitrokhin V.M. – Ph.D., assistant professor department of physiology, Pirogov Russian National  Research Medical University
  • Kiryuschenkov G.P.- Physician at the Medical centre «RostAgroExport»
  • Prudnikov N.D. – Physician at the Medical centre «RostAgroExport»
  • Kharlamov E.Yu. – Associate Professor, Department of Informatics, University of Oslo; 
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Introduction. Impact of perineal muscles strengthening exercises on penile hemodynamics in patients with erectile disfunction (ED) was studied.

Materials and methods. Complete physical examination of patients was performed, including examination by a therapist, urologist, including medical tests and instrumental methods of examination. Patients with psychogenic erectile disfunction were excluded. The study engaged 24 men with the mean age 47,7±2,5 years ranging from 22 to 74 years, with a duration of ED of 19±2,9 months and scores on IIEF-5 scale 16,4±0,8. All patients gave written informed consent. In all patients power in perineal muscles was measured and Doppler sonography during pharmacologically induced erection was performed after intracavernosal injection of alprostadil (10 μg). Blood flow parameters in cavernosal and dorsal arteries and in deep dorsal vein in all phases of erection (flaccid state, tumescence, full erection) were measured. In fully erect state rigidity of the penis was evaluated. All patients underwent a course of perineal muscles strengthening exercises. After this training power in perineal muscles was measured and Doppler sonography during pharmacologically induced erection was performed again.

Results. After perineal strengthening exercises power in perineal muscles increased on average in 3,4 times (p<0,001). In 16 patients (67%) recovery of normal erectile function (EF) was noted. Initially all patients had similar penile blood flow parameters in flaccid and in tumescence states. In patients with subsequent EF recovery reliably higher values of systolic acceleration in cavernosal arteries in fully erect state were measured – 477±40 cm/s². In patients without EF recovery systolic acceleration was 290±30 cm/s². In patients without EF recovery penile hemodynamics after the course of exercises did not change. In patients with EF recovery following findings were indicated: reliably higher values of peak systolic velocity (PSV) and systolic acceleration in cavernosal arteries, also diastolic backflow appeared, thus indicating increase of intracavernosal pressure (ICP) over systemic diastolic pressure; twofold reduction of outflow in deep dorsal vein. Changes in hemodynamics in this group of patients resulted in reliable increase of penile rigidity.

Conclusions. Systolic acceleration in cavernosal arteries in a fully erect penis is a significant prognostic criterion for EF recovery after the course of perineal strengthening exercises.

Conflict of interest. The authors declare no conflict of interest

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erectile disfunction, perineal muscles, penile hemodynamics, cavernosal arteries.

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