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.