Discussion
ED is a serious health problem that affects the lives of both men and
their partners. Its prevalence in men increases with age. There are
several factors in its etiology, including vascular, neuronal, hormonal
and psychological factors.21 The corpus cavernosum in
the penis consists of a highly specialized vascular structure that
promotes erection. Approximately 50% of the cross-sectional anatomy of
the penis consists of smooth muscle cells (SMC).22Another important structural unit of the penis is collagen. SMC and
collagen not only build structure but are also responsible for penile
erection.23 It has been shown that the number of SMCs
is reduced in ED cases.24,25 In addition, studies have
shown that the collagen content of the penis is altered in cases of ED .
Usually, Doppler ultrasonography is the preferred imaging method in
cases where a comprehensive examination and treatment methods need to be
determined. Radiological imaging has limited use in the diagnosis and
treatment of ED. As a new noninvasive sonographic method, SWE is a fast
and practical radiological method used to quantitatively evaluate tissue
stiffness.26
Zhang et al. reported that SWE can quantitatively show SMC in the rat
penis. Smaller amounts of SMC resulted in higher measurements in SWE.
The relationship between SWE measurement values in the mouse penis and
histopathological examination findings concluded that SWE can be used in
the quantitative evaluation of penile SMCs.27 It
should also be noted that the amount of SMC in the penile tissue
decreases with age.24,25,26 Therefore, it is unclear
how changes in SWE measurements only relate to changes in collagen
tissue and neglect the contribution of the change in the amount of SMCs.
Rüştü Türkay et al. found lower SWE in ED patients compared to the
control group (group 1: 20.94-1.23 kPa, group 2: 24.63-1.7.58 kPa).
According to this study, using a 17.1 kPa SWE Cutoff, higher specificity
( 95%) and a positive predictive value (85%). The amount of SMCs
decreases in ED cases. A study involving rat penises showed that a
reduced amount of SMC was associated with higher penile SWE
values.28,29 As far as we know, there are no studies
that describe how ED can change SWE measurement values in humans. ED
is a complex pathology that can develop due to various factors. Tissue
response may vary depending on the nature of the cause of the
disease.21
On the other hand, how long ED patients have been with this problem is
also important. We believe that the duration of the disease can affect
the amount of SMC and collagen in the tissue. In our study, a positive
correlation was found between the increase in right and left cavernous
body elastic fiber score and right and left penile elastographic
cavernous body measurements, but it was not statistically significant
due to the insufficient number of patients.
There was no correlation or statistical significance between right and
left penile elastography cavernous body measurement results and right
and left cavernous body masson trichrome staining percentage
measurements. There was a positive correlation between the right and
left cavernous body elastic fiber scores compared to the percentage of
right and left cavernous body masson trichrome staining, but was not
statistically significant according to the Kruskal Wallis Test and
Spearman’s correlation test. The fact that the pathology results were
also incompatible for themselves and the insufficient number of patients
limited our study. The inability to biopsy the cavernous body tissue of
healthy volunteers and the absence of our control group are another
factor limiting our study. In the studies in the literature, obtaining
pathology samples from rats made our study superior to others.
In addition, studies in the literature have shown that; Due to its high
specificity and positive predictive value, SWE can provide valuable data
in the radiological evaluation of ED patients. SWE evaluations can also
provide additional data in the selection of treatment options. We
believe that further studies with SWE may contribute to the more
frequent use of radiological imaging in these patients. Due to its high
specificity and positive predictive value, SWE can provide valuable data
in the radiological evaluation of ED patients. SWE evaluations can also
provide additional data in the selection of treatment options. We
believe that further studies with SWE may contribute to the more
frequent use of radiological imaging in these patients.