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.