İntroduction
Penile erection is a complex phenomenon that creates a sensitive and
coordinated balance between the vascular, psychological, neurological
and smooth muscle compartment. It includes arterial dilatation,
activation of the penile corporeal veno-occlusive mechanism and
trabecular smooth muscle relaxation in spongiosa
tissue.1 Erectile dysfunction (ED) is defined as the
inability to maintain an adequate erection to achieve satisfactory
sexual performance and maintain an erection.2 Erectile
dysfunction can affect physical and psychosocial health and
significantly affect the quality of life of patients and their
wifes.3,4,5 The density of ED in men aged 40-70 study
conducted in 69% in Turkey.6,7 Although it was
previously believed that ED is primarily due to psychological factors,
today it is known that there is an underlying organic pathology in most
of the cases.8 The penis is primarily composed of
sinusoids, smooth muscle cells (SMC), corpora cavernosa, endothelial
cells and corpus spongiosum, which contain fibrocytes and elastic fibers
that form the anatomical principles of penile erection.The tissue
formation of the penis is nearly related to the erectile function of the
penis.9 The change in the tissue structure of the
penis (such as the reduction of SMCs, the amount and density of
sinusoids, the amount and density of fibrocytes) is directly related to
the occurrence and severity of erectile dysfunction
(ED).10 Timely diagnosis of penile tissue
abnormalities is very important for the etiological diagnosis of ED. The
only way to diagnose a change in the tissue structure of the penis is to
biopsy the cavernous tissue.11 Since biopsy is an
invasive method, its clinical application is very limited. Therefore, it
is of great clinical importance to investigate a non-invasive and
non-contraindicated method for evaluating the tissue structure of the
penis. .Real-time two-dimensional ShearWave Elastography (2D-SWE) is a
new ultrasound quantitative measurement technology. The basic principle
is to use ultrasonic pulses to make the tissue generate transverse shear
waves and shear wave velocity (SWV) is to determine the
exact.12,13 Using SWV to calculate tissue stiffness,
we obtain the quantitative value of tissue stiffness. Since SWV is
determined by the structural properties of the tissue, shear wave
stiffness (SWS) is a quantitative parameter that can reflect the tissue
structure.14 At the same time, the 2D-SWE examination
is non-invasive and can be performed at any time without
contraindications. Thus, we think that 2D-SWE is expected to be a new
clinical method for evaluating the tissue structure of the
penis.15 There are two main types: strain elastography
and shear wave elastography (SWE). The accuracy of the results largely
depends on the ability of the user and strain elastography is a
semi-quantitative method.16,17 Ultrasonographic waves
produced by the transducer generate region of interest (ROI) and shear
waves in the tissue.18 These waves are detected by the
transducer and the velocities of the waves are used to calculate the
tissue young modulus, which is directly related to the stiffness of the
tissue.19 Shear wave propagation velocity is
proportional to tissue stiffness, which increases with
fibrosis.20 To our knowledge, a limited number of
previous studies have evaluated the efficacy of SWE in the diagnosis of
ED. In this study, we aimed to determine the efficacy of SWE in the
diagnosis of ED and to discuss its potential contributions to the
management of ED