Methods
The study was planned in accordance with the Helsinki Declaration decisions, patient rights regulations and ethical rules. The research was started after the approval of the Medical Research Ethics Committee of Manisa Celal Bayar University Faculty of Medicine. Ethics committee number: 25/12/2019/20.478.486. 12 patients who applied to our clinic for erectile dysfunction in the last 1 year and accepted this study were included . These patients had erectile dysfunction for at least 3 years, did not benefit from phosphodiesterase 5 inhibitor drugs, did not have an erection and tumescent response in the Penile Doppler USG performed in our Hospital Radiology Department, and accepted penile prosthesis implantation. Patients who were diagnosed with Peyronie’s disease or had a history of penile trauma or penile operation for any reason were excluded from the study.
Preoperative (2-3 days ago) SWE imaging was performed by an experienced radiologist with a linear transducer (12-16 MHz) using the Aplio 500 platinum (Toshiba, Tokyo, Japan) 2D- SWE device to the patients participating in our study. They were asked to grasp and place the penile shaft in the groin area. Measurements were made from the middle part of the penis (flaccid) with the probe held in a transverse plane. The ROI circle was placed 1 cm deep to the corpus cavernosum penis (Figure 1 and 2). Six measurements were taken per patient, three from the right and left cavernous, and these measurements were recorded as T1, T2 and T3. The median value of these measurements was expressed as Tmed. Measurement results were recorded in kilo Pascal (kPa). Penile prosthesis implantation was performed by penoscrotal technique in all patients. After passing through the penoscrotal skin and subcutaneous layers, the right and left cavernous body tunica albuginea was incised, and tissue samples of approximately 0.5x0.5x0.5 cm were taken from the right and left spongiosis tissue. The samples taken did not cause any deformity in the penis. After the sample tissues were taken, a penile prosthesis was inserted into the cavernous body. The samples taken were sent to our hospital pathology department in separate containers. Paraffin embedded blocks were prepared in formalin from tissue samples taken from the right and left corpus cavernosum. The 4μ thick sections obtained from the blocks were stained with Hematoxylin & Eosin (HE), Masson-trichrome(Figure 3A and 3B) and Verhoff’s elastic dye(Figure 4A and 4B). By evaluating the HE and Masson-trichrome stained sections together, the ratio of muscle fibers and collagenized areas in the distance between the vascular channels of the corpus cavernosum was examined, and the percentage of the area covered by the muscle fibers was noted semiquantitatively (Grouped %10,%20,%30… %100). The decrease in the ratio of muscle fibers was interpreted as an increase in connective tissue. In the evaluation of the elastic fibers, a semi-quantitative scoring was made by considering the presence and density of the elastic in the distance between the vascular canals. Accordingly, if the elastic fibers are observed more than 50% of the distance, the score is 3; If 50-25% is monitored as decreased, the score is 2; The score was evaluated as 1 if it was observed in less than 25% area and diluted.