The Color Flow Penile Duplex Ultrasound

The ultrasound test can image the anatomy the penis, non-invasively. The corpora cavernosa, which are the paired erectile bodies, can be seen with the corpus spongiosum and urethra ventrally.

When applying the doppler signal to the flaccid penis, we can get a measure of blood flow.
Ten or so minutes after injecting the penis with a vasodilator, you can see the increase in flow velocity. The tall peaks represent systolic flow, or when blood is entering the penis. The shorter regions represent diastolic flow, which is a measure of venous function.
After 30 minutes, the man has a rigid erection, and there is no venous flow. The arterial flow has peaked. This man has normal vascular function in his penis and his ED is unlikely to be the result of a vascular problem.Use of color flow duplex ultrasound can be a useful evaluation tool for certain men with ED.

How I Do a Testis Sperm Extraction

This is a good, safe, & reliable method to do a testis sperm extraction in a patient with obstructive azoospermia.

After informed consent, I take the patient to the OR suite. He is given some mild sedation and shaved, prepped, & draped in a sterile fashion. I do an exam with him sedated. I do a cord block with ~8cc of 0.5% marcaine with lidocaine plain. I then hold the skin taught over the testis and infiltrate the scrotal skin with the lido mixture. I then, after I confirmed that he is numb, make a 2cm transverse scrotal incision and deepen it through the scrotum until I exposed the testis in the tunica vaginalis (TV) sack. Hemostasis is obtained with the bovie. I then open the TV to expose the testis and the tunica albuginea (TA). I then place a 5-0 monocryl stitch into the TA at the upper pole of the right testis and tie it. I then make a small longitudinal opening in the TA with a beaver blade. Seminiferous tubules extrude through the opening and these I remove with the scissors and give them to the embryology team. I obtain hemostasis at this point with the bipolar cautery and close the opening in the TA with the previously placed monocryl as a running, interlocking stitch. I then repeat the process several times more until embryology tells me that have sperm in sufficient quantity to freeze, thaw, and use for ICSI, in the case of a patient with obstructive azoospermia. At this point, all the openings in the TA will have been closed as above. I then close the TV with 3-0 vicryl as a running, interlocking hemostatic stitch and close the skin and dartos in 1 layer with a running, interlocking 5-0 monocryl suture. I then clean off the dried prep, place bacitracin ointment on the wound, and fluffs. This ends the procedure.

RS