CT Cavernosography: a Patient-Centered Approach to Understanding Functional Penile Abnormalities
Diana Aponte-Colon, BS1, James Trussler, MD, MS2, Mohanned Alnammi, MD2, Sebastian Flacke, MD2, Andrew McCullough, MD2.
1Tufts University School of Medicine, Boston, MA, 2Lahey Hospital and Medical Center, Burlington, MA.
BACKGROUND: Patient-centered care focuses on maximizing patients' physical and emotional well-being. A key aspect to delivering patient-centered care is creating a partnership between the patient and practitioner and integrating both physician and patient knowledge through shared decision-making. Men with functional penile abnormalities are at higher risk of experiencing physical and emotional dissatisfaction. Interventions aimed at patient education may significantly improve patient quality of life and potentially affect response to treatment. CT cavernosography (CTC) is an emerging imaging technique that has been used to evaluate penile anatomy in conditions such as Peyronie's disease and erectile dysfunction . The aim of this study was to use a patient-reported outcome questionnaire to determine the efficacy of CTC in helping patients with functional penile abnormalities understand their condition and treatment options. We also assessed the pain attributed to the use of CTC and whether patients thought this was a valuable tool in the diagnosis of their condition when taking into account the discomfort of the test versus the information gained.
METHODS: Before the procedure, patients were informed about the role for CTC in evaluating their condition. The method for CTC has been previously described. Briefly, a maximal erection was induced by combination of intracavernosal injection and inflation with 50% iodinated contrast media. A pelvic CT scan was then obtained. After the scan, images including 3D reconstructions were discussed with the patients and a 6-item questionnaire was administered for purposes of quality control. The 6 questions concerned pain associated with the procedure, informedness about the procedure, impact of the CTC on patient understanding of the disease process and treatment options, impact of the CTC on decision making, and value obtained from the CTC results. Patients rated the questions on a scale of 1-5 or 1-10.
RESULTS: A total of 29 men aged from 22 to 71 years who underwent CTC for erectile dysfunction (45%), erectile dysfunction with comorbid penile curvature (34%), or other functional penile abnormalities (21%) between October 2019 and March 2020 were included. Patients reported feeling well-informed about the need for the CT scan (M= 4.8/5, SD= 0.8). They also reported that the CT scan gave them a clear understanding of their condition (M= 4.8/5, SD= 0.8) and helped them understand their treatment options (M= 4.7/5, SD= 0.8). Additionally, the scan helped them decide on their next treatments (M= 4.7/5, SD= 0.8). The average pain score attributed to the CTC was low (M=2.9/10, SD=2). Fifteen patients required either no pharmacologic reversal or a single dose of phenylephrine. Four patients had a prolonged erection after the procedure requiring corporal aspiration. After weighing the discomfort of the test versus the information gained, patients felt that the CTC was important in the diagnosis of their condition (M=4.8/5, SD= 0.4).
CONCLUSIONS: The use of CTC in patients with functional penile abnormalities is associated with low pain, improved patient understanding of the disease and treatment options, and high patient satisfaction.
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