Erectile dysfunction due to ectopic penile vein

Physiology of Erection and Pathophysiology of Erectile Dysfunction

The science of penile erection, including recent advances in its molecular physiology and neuroanatomic pathways, is described. The pathophysiology of erectile dysfunction is presented, acknowledging associated disease states, and accordingly follows a practical classification scheme: vasculogenic, neurogenic, endocrine, and psychogenic.

Embolotherapy for venous impotence: use of ethanol

PURPOSE

To evaluate the usefulness of embolotherapy with ethanol for the treatment of venous impotence.

MATERIALS AND METHODS

Twenty-three patients with venous impotence underwent embolotherapy. The diagnosis of venous impotence was made by means of pharmacocavernosometry and cavernosography. After exposure of the deep dorsal penile vein, a intravenous catheter was inserted directly into the deep dorsal penile vein and advanced into just front of the preprostatic plexus. Fifty percent ethanol was injected through the catheter and the endpoint of the procedure was determined based on results of venography immediately after injection. The procedure was finished when lack of venous leakage was confirmed.

RESULTS

In all patients, the deep dorsal penile vein was successfully exposed surgically, the sclerosing agent successfully injected, and the endpoint successfully achieved. Immediate clinical therapeutic effect (restoration of erection) was obtained in 20 cases (87%). No severe complications were observed during or after the procedure. The follow-up period was 6-50 months. Long-term therapeutic effect was confirmed for 18 of 23 patients (78%).

CONCLUSION

The authors' findings suggest that this treatment had satisfactory short-term and long-term clinical results and that longer follow-up is necessary to confirm its safety.

Surgery for crural venous leakage

A procedure for congenital or acquired crural venous leakage is described. A 3-in.-long inguinoscrotal incision is made about 1 in. lateral to the penis. The suspensory ligament is incised, and the penis is detached from the pubic bone. The deep dorsal vein is resected to expose the hilum of the penis. The entrance of the cavernous artery to the corpus cavernosum is identified. The paired dorsal arteries and nerves, cavernous arteries and nerves, and the bulb of the corpus spongiosum are dissected off the crura. Two umbilical tapes are used to ligate the proximal portion of each crus proximal to the entrance of the cavernous artery to shut off the venous leakage.

Congenital defect in sinusoidal smooth muscles: a cause of organic impotence

We report 2 cases of primary impotence due to a congenital defect in the compliance of the sinusoidal spaces secondary to fibrosis and atrophy of the smooth muscles. Both patients were young adults at presentation. Diagnosis of this rare entity was achieved by penile Doppler ultrasound and cavernosometry/cavernosography of the cavernous bodies. Both patients underwent placement of a penile prosthesis, during which biopsy samples of the cavernous tissue were obtained, and diagnosis was confirmed by light and electron microscopy.

Diagnosis of venous incompetence in erectile dysfunction. Comparative study of cavernosography and Doppler ultrasound

In 26 of 214 patients with erectile dysfunction and proved venous incompetence by cavernosography, an additional bidirectional Doppler ultrasound was performed also to demonstrate venous outflow disturbances. All except one leakage in the superficial and deep dorsal veins could be demonstrated as well as 4 of 6 cavernosum-glandular shunts. Bidirectional Doppler ultrasound visualized a continuous retrograde blood flow from the sulcus coronarius to the root of the penis in superficial and deep dorsal penile veins as well as in ectopic penile veins, an orthograde blood flow in the sulcus coronarius in cavernosum-glandular shunt.

Quantitative and qualitative analysis of dynamic cavernosographies in erectile dysfunction due to venous leakage

Of 521 patients with erectile dysfunction in whom a multidisciplinary approach was used, 145 (27.8%) showed venous leakage as (concomitant) etiology of the impotence in dynamic cavernosography. The rate of the maintenance flow corresponded well with the response to a standardized intracavernosal injection of vasoactive drugs (p less than 0.05) in patients with venous leakage. The maintenance flow increased with the age in secondary impotent men. It was not statistically different in patients with or without concomitant arterial insufficiency (p = 0.19). Fifty-one of 145 patients (32.2%) presented a pathologic cavernosal drainage via a single venous system; 94/145 (64.8%) showed a combined venous leakage. The type of leakage corresponded neither to the maintenance flow nor to the response to intracavernosal injections. Our findings show that standardized intracavernosal testing and Doppler have a high predictive value for the status of the venous occlusive system. Exact evaluation of the type of leakage can be made by bidimensional cavernosography only.

Primary erectile dysfunction

We evaluated 67 patients 18 to 60 years old (mean age 28.5 years) with primary erectile dysfunction (absence of full sustained erections since early childhood or puberty) using a multidisciplinary approach. Organic causes of the erectile dysfunction were found in 57 of the 67 patients (85 per cent): 12 (18 per cent) had neurological, 35 (52 per cent) arteriogenic and 35 (52 per cent) venogenic abnormalities. Psychogenic factors were diagnosed in 11 patients (16 per cent), while in 4 (6 per cent) a classification was not possible. Concomitant psychogenic abnormalities were found in 39 of the 57 patients (68 per cent) with organic primary erectile dysfunction. Our results suggest that primary erectile dysfunction is caused mainly by organic factors. However, for successful therapy the frequent secondary psychogenic abnormalities must be considered.