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