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A novel method for hemodynamic analysis of penile erection

International Journal of Impotence Research volume 34, pages 55–63 (2022)Cite this article

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Abstract

Measurement of blood flow velocity through the cavernosal arteries via penile color Doppler ultrasound (PDUS) is the most common objective method for the assessment of erectile function. However, in some clinical cases, this method needs to be augmented via the invasive intracavernosal pressure (ICP) measurement, which is arguably a more direct index for erectile function. The aim of this study is to develop a lumped parameter model (LPM) of the penile circulation mechanism integrated to a pulsatile, patient-specific, bi-ventricular circulation system to estimate ICP values non-invasively. PDUS data obtained from four random patients with erectile dysfunction are used to develop patient-specific LPMs. Cardiac output is estimated from the body surface area. Systemic pressure is obtained by a sphygmomanometer. Through the appropriate parameter set determined by optimization, patient-specific ICP values are predicted with only using PDUS data and validated by pre- and post-papaverine injection cavernosometry measurements. The developed model predicts the ICP with an average error value of 3 mmHg for both phases. Penile size change during erection is predicted with a ~15% error, according to the clinical size measurements. The developed mathematical model has the potential to be used as an effective non-invasive tool in erectile function evaluation, expanding the existing clinical decision parameters significantly.

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Fig. 1: Mathematical networks to simulate the blood flow through the lumped elements.
Fig. 2: Schematic representation of the two-step particle swarm optimization algorithm of penile erection circulation system parameters.
Fig. 3: Measured PDUS and cavernosometry data.
Fig. 4: Sensitivites of the pressures and flow rates to the compliance and resistance lumped parameters.
Fig. 5: Waveform comparison of simulated and measured cavernosal artery flow after the papaverine injection.
Fig. 6: Change of the penile parameters during transition from flaccid to erect states.
Fig. 7: Pressure and flow waveforms of the systemic parameters and cavernosal arteries.

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Authors and Affiliations

  1. Department of Mechanical Engineering, Bogazici University, Istanbul, Turkey

    Canberk Yildirim & Hakan Erturk

  2. Department of Mechanical Engineering, Koc University, Istanbul, Turkey

    Kerem Pekkan

  3. Department of Radiology, Koc University Hospital, Istanbul, Turkey

    Sinan Deniz

  4. Department of Urology, Biruni University School of Medicine, Istanbul, Turkey

    Ege Can Serefoglu

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Correspondence to Ege Can Serefoglu.

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Yildirim, C., Erturk, H., Pekkan, K. et al. A novel method for hemodynamic analysis of penile erection. Int J Impot Res 34, 55–63 (2022). https://doi.org/10.1038/s41443-020-00362-y

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