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Hsieh CH, Hsu GL, Chang SJ, Yang SSD, Liu SP, Hsieh JT. Surgical niche for the treatment of erectile dysfunction. Int J Urol 2019; 27:117-133. [PMID: 31812157 DOI: 10.1111/iju.14157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
Penile erection implicates arterial inflow, sinusoidal relaxation and corporoveno-occlusive function. By far the most widely recognized vascular etiologies responsible for organic erectile dysfunction can be divided into arterial insufficiency, corporoveno-occlusive dysfunction or mixed type, with corporoveno-occlusive dysfunction representing the most common finding. In arteriogenic erectile dysfunction, corpora cavernosa show lower oxygen tension, leading to a diminished volume of cavernosal smooth muscle and consequential corporoveno-occlusive dysfunction. Current studies support the contention that corporoveno-occlusive dysfunction is an effect rather than the cause of erectile dysfunction. Surgical interventions have consisted primarily of penile revascularization surgery for arterial insufficiency and penile venous surgery for corporoveno-occlusive dysfunction, whatever the mechanism. However, the surgical effectiveness remained debatable and unproven, mostly owing to the lack of consistent hemodynamic assessment, standardized select patient and validated outcome measures, as well as various surgical procedures. Penile vascular surgery has been disclaimed to be the treatment of choice based on the currently available guidelines. However, reports on penile revascularization surgery support its utility in treating arterial insufficiency in otherwise healthy patients aged <55 years with erectile dysfunction of late attributable to arterial occlusive disease. Furthermore, it is noteworthy that penile venous surgery might be beneficial for selected patients with corporoveno-occlusive dysfunction, especially with a better understanding of the innovated venous anatomy of the penis. Penile vascular surgery might remain a viable alternative for the treatment of erectile dysfunction, and could have found its niche in the possibility of obtaining spontaneous, unaided and natural erection.
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Affiliation(s)
- Cheng-Hsing Hsieh
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Geng-Long Hsu
- Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology, Taipei, Taiwan
| | - Shang-Jen Chang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Stephen Shei-Dei Yang
- Department of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ju-Ton Hsieh
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, National Taiwan University, Taipei, Taiwan
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2
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Fuga venosa dorsal profunda como causa de disfunción eréctil primaria y secundaria no estándar (serie de 57 casos). Rev Urol 2017. [DOI: 10.1016/j.uroco.2016.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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3
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Lee D, Rotem E, Lewis R, Veean S, Rao A, Ulbrandt A. Bilateral external and internal pudendal veins embolization treatment for venogenic erectile dysfunction. Radiol Case Rep 2016; 12:92-96. [PMID: 28228888 PMCID: PMC5310371 DOI: 10.1016/j.radcr.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/10/2016] [Accepted: 11/12/2016] [Indexed: 11/04/2022] Open
Abstract
Erectile dysfunction (ED) or impotence is estimated to affect around 20-30 million men in the United States (Rhoden et al, 2002). Vascular etiology is purported to be the most prevalent cause of ED in the elderly population, with venogenic ED being the most common subtype (Shafik et al, 2007; Rebonato et al, 2014). A patient, who developed severe venogenic ED, was referred to interventional radiology after ineffective pharmaceutical treatments. Selective embolization of bilateral external and internal pudendal veins was performed through accessing the deep dorsal vein of penis. Subsequent venogram verified successful embolization with stasis within the outflow of the deep dorsal vein of penis. Close to 6 weeks after the procedure, the patient purports to be able to achieve approximately 65% of full penile erection and complete penile erection with penile stimulation and 0.25 mL injection of alprostadil after 25 minutes.
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Affiliation(s)
- Daniel Lee
- Medical College of Georgia, Augusta University, 1120 15th St. Augusta, GA 30912, USA
| | - Eran Rotem
- Department of Radiology, Interventional Radiology Section, Augusta University Medical Center, 1120 15th St. Augusta, GA 30912, USA
| | - Ronald Lewis
- Department of Urology, Augusta University Medical Center, 1120 15th St. Augusta, GA 30912, USA
| | - Satyam Veean
- Medical College of Georgia, Augusta University, 1120 15th St. Augusta, GA 30912, USA
| | - Ashwin Rao
- Department of Radiology, Augusta University Medical Center, 1120 15th St. Augusta, GA 30912, USA
| | - Alison Ulbrandt
- Department of Radiology, Augusta University Medical Center, 1120 15th St. Augusta, GA 30912, USA
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Hsieh CH, Hsieh JT, Chang SJ, Chiang IN, Yang SSD. Penile venous surgery for treating erectile dysfunction: Past, present, and future perspectives with regard to new insights in venous anatomy. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2015.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Papel de las imágenes en el diagnóstico y tratamiento intravascular de la disfunción eréctil por fuga venosa en un paciente joven. Rev Urol 2016. [DOI: 10.1016/j.uroco.2015.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hsieh CH, Tsai HC, Hsu GL, Chen CC, Hsu CY. Herb formula enhances treatment of impotent patients after penile venous stripping: a randomised clinical trials. Andrologia 2015; 48:754-60. [PMID: 26688463 DOI: 10.1111/and.12508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2015] [Indexed: 02/06/2023] Open
Abstract
Herbs have been regarded as aphrodisiacs in treating impotence for many centuries despite little true scientific evidence. Our latest refined penile venous stripping (PVS) technique is effective in treating impotence, although this procedure remains controversial. A synergic effect of PVS and oral herbs was confirmed in our practice but lacked rigorous scientific proof. The objective of this report was to review our experience with this combination. From August 2010 to May 2014, 263 males underwent PVS. Among these, 67 unsatisfied men chose additional salvage therapy and were randomly assigned to oral herbs (n = 35) or placebo treatment (n = 32) which replaced herb eventually. All were evaluated with the international index of erectile function (IIEF-5) scoring and our dual pharmaco-cavernosography. The pre-op IIEF-5 score for the herb group was 9.7 ± 3.7, post-operative 13.9 ± 3.3 and post-herb 19.6 ± 3.4, while the control group scores were as follows: pre-op 9.3 ± 4.1, post-op 14.5 ± 3.6, post-placebo 15.1 ± 3.5 and post-herb 19.9 ± 3.2. Although there was no significant difference between the two groups pre-operatively, post-operatively and post-herb, a statistically significant difference was found post-salvage therapy (19.6 ± 3.4 versus 15.1 ± 3.6, P < 0.001). It appears that the combination of oral herbs and PVS treatment provides an enhanced outcome to impotent patients refractory to medicine and unsatisfied with PVS monotherapy alone.
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Affiliation(s)
- C-H Hsieh
- Department of Urology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - H-C Tsai
- Department of Urology, College of Medicine, National Taiwan University Hospital, Taipei City, Taiwan
| | - G-L Hsu
- Department of Urology, College of Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology, Taipei City, Taiwan
| | - C-C Chen
- Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology, Taipei City, Taiwan
| | - C-Y Hsu
- Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology, Taipei City, Taiwan
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Hsieh CH, Huang YP, Tsai MH, Chen HS, Huang PC, Lin CW, Hsu GL. Tunical Outer Layer Plays an Essential Role in Penile Veno-occlusive Mechanism Evidenced from Electrocautery Effects to the Corpora Cavernosa in Defrosted Human Cadavers. Urology 2015; 86:1129-35. [PMID: 26428700 DOI: 10.1016/j.urology.2015.07.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 06/03/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the exact anatomical structure for establishing penile veno-occlusive function, we sought to conduct a hemodynamic study on defrosted human cadavers. MATERIALS AND METHODS Thirteen penises were used for this experiment, and 11 intact penises were allocated into the electrocautery group (EG, n = 6) and the ligation group (LG, n = 5). A circumcision was made on the penis to access the veins. Two #19 scalp needles were fixed in the 3 and 9 o'clock positions in the distal penis for colloid infusion and intracavernous pressure (ICP) monitoring, respectively. For the EG, the deep dorsal vein and cavernosal vein trunks were freed for 3-5 cm where at least 3 emissary veins were identified via opening Buck's fascia; these veins underwent electrocautery at 45 watts, while the ICP was maintained at 0, 50, 75, 100, 125, and 150 mmHg, respectively. For control, venous ligation was made but at the ICP of 150 mmHg. A tissue block including the emissary vein was then obtained for histological analysis. RESULTS Except all in the EG and those whose ICP exceed 125 mmHg in the EG, the sinusoids of the corpora cavernosa sustained varied fulgurated fibrosis in every specimen and the severity appeared reversely commensurate with the ICP regarding sinusoidal clumping and darkish bands (P <.02 and .01 respectively). CONCLUSION We conclude that the tunica albuginea can prevent the electrocautery damage to intracavernous sinusoids once the ICP reached a level corresponding to a rigid erection. The outer tunica plays an essential role in fulfilling the veno-occlusive mechanism.
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Affiliation(s)
- Cheng-Hsing Hsieh
- Department of Urology, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Yi-Ping Huang
- Department of Physiology, China Medical University, Taichung, Taiwan
| | - Mang-Hung Tsai
- Department of Anatomy, China Medical University, Taichung, Taiwan
| | - Heng-Shen Chen
- Department of Medical Informatics & Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Po-Cheng Huang
- Department of Plastic Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Chung-Wu Lin
- Department of Pathology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Geng-Long Hsu
- Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology, Taipei, Taiwan.
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8
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Embolization of the Periprostatic Venous Plexus for Erectile Dysfunction Resulting from Venous Leakage. J Vasc Interv Radiol 2014; 25:866-72. [DOI: 10.1016/j.jvir.2014.01.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 01/12/2014] [Accepted: 01/14/2014] [Indexed: 11/20/2022] Open
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9
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Kawanishi Y, Izumi K, Muguruma H, Mashima T, Komori M, Yamanaka M, Yamamoto A, Numata A, Kishimoto T, Kanayama HO. Three-dimensional CT cavernosography: reconsidering venous ligation surgery on the basis of the modern technology. BJU Int 2010; 107:1442-6. [DOI: 10.1111/j.1464-410x.2010.09644.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Hellstrom WJG, Montague DK, Moncada I, Carson C, Minhas S, Faria G, Krishnamurti S. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med 2010; 7:501-23. [PMID: 20092450 DOI: 10.1111/j.1743-6109.2009.01626.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The field of erectile dysfunction (ED) is evolving and there is a need for state-of-the-art information in the area of treatment. Aim. To develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery. METHODS To provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURE Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. RESULTS The inflatable penile prosthesis (IPP) is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis. Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma. Currently, surgery to limit venous leakage is not recommended. CONCLUSIONS It is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient's medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery.
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Affiliation(s)
- Wayne J G Hellstrom
- Tulane University School of Medicine, Department of Urology, New Orleans, LA 70112, USA.
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11
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Glina S, Tan HM, El-Sakka AI, Nehra A. Classic Citations: Further Experience With an Operation for the Cure of Certain Types of Impotence
O.S. Lowsley, and A. Rueda. J Sex Med 2009; 6:2096-101. [DOI: 10.1111/j.1743-6109.2009.01387.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Çayan S. Primary Penile Venous Leakage Surgery With Crural Ligation in Men With Erectile Dysfunction. J Urol 2008; 180:1056-9. [DOI: 10.1016/j.juro.2008.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Selahittin Çayan
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
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13
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Abstract
A wide variety of medications, devices, and surgical interventions are available to patients who have ED. These range from first-line oral agents to second-line therapy with injections or vacuum devices to third-line options, such as penile prosthesis implantation. In this article, we cover available treatments for erectile dysfunction, ranging from first-line to third-line therapies.
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Affiliation(s)
- William O Brant
- University of Colorado School of Medicine, P.O. Box 40,000, Vail, CO 81658, USA.
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14
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Abstract
Epidemiological studies have demonstrated an age-stratified increase in the incidence and prevalence of erectile dysfunction (ED). There is a greater degree of openness today when discussing sexual matters and more information on the treatment of ED is available to the public through the media. Quality-of-life issues are now a matter of great importance to the aging population. Men and their partners are no longer prepared to merely accept ED as a natural consequence of aging. The advent of a simple and effective oral therapy for ED has also indirectly fueled the increase in treatment-seeking behaviour among men. Despite great strides in research into ED, our knowledge and understanding of the pathophysiological mechanisms is still in its infancy. As a result, we are able to treat only the symptom of ED rather than prevent it. Common diseases found in the population, such as diabetes mellitus and coronary artery disease appear to be risk factors for the development of ED. Therefore, physicians need to identify any underlying co-existing organic diseases in their patients presenting with ED. Whenever possible, patients are encouraged to attend their consultation sessions with their partners because ED is a condition affecting 'the couple' and not just the man. Psychogenic aspects of ED should also be explored during the consultation. Efforts need to be made to uncover and address the presence of any psychological stressors, if necessary with the help of a psychosexual therapist. The first-line treatment of ED is oral phosphodiesterase-5 inhibitors. For those who do not respond to oral therapy, there is no defined 'step-ladder' escalation in alternative therapy. It is up to the physician to discuss the options with the patient or couple and reach a decision based on their preference.
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Wen HS, Hsieh CH, Hsu GL, Kao YC, Ling PY, Huang HM, Wang CJ, Einhorn EF. The synergism of penile venous surgery and oral sildenafil in treating patients with erectile dysfunction. ACTA ACUST UNITED AC 2005; 28:297-303. [PMID: 16128990 DOI: 10.1111/j.1365-2605.2005.00554.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A possible synergistic effect between penile venous surgery and oral sildenafil was inadvertently found in treating patients with erectile dysfunction in our clinic. We therefore sought to elucidate the possible synergic effect between venous surgery and sildenafil through studying patients who were non-responders preoperatively. From July 1998 to July 2003, 128 patients were diagnosed with veno-occlusive dysfunction. Subsequently, 65 of them underwent penile venous surgery and were assigned to the surgical treatment group. The remaining 63 men were assigned to the control group, and were subject to a simple re-exposure of oral sildenafil. All patients were evaluated with the international index of erectile function (IIEF-5) scoring. Sildenafil (12.5-100 mg) was prescribed postoperatively to all surgical patients as venous surgery alone was unsatisfactory and similarly, 100 mg preparation was prescribed for patients in the control group. The IIEF-5 scoring in the control group changed from a preoperative mean IIEF-5 score of 9.4 +/- 3.9 to 10.7 +/- 3.5 postoperatively. In surgical patients, however, the mean preoperative IIEF-5 score of 9.2 +/- 5.0, which increased to 15.1 +/- 5.0 (p < 0.001) postoperatively, further increased to 20.1 +/- 5.4 (p < 0.0001) after the addition of sildenafil. Although there was no significant difference between the two groups characteristics, there was a statistically significant difference between treatment results (p < 0.001). Overall, 61 men (93.8%) reported a positive response to sildenafil after venous stripping surgery. In contrast, only eight patients (12.7%) felt a beneficial response in the control group (p < 0.001). Forty-one of 65 patients had scores of > or =22, and 19 of these had a score of 25. No response was found in three (4.6%), and a decrease of 7 was seen in one (1.5%). In summary, patients in whom sildenafil was not effective preoperatively can become excellent responders after careful penile venous surgery. It appears that together, oral sildenafil and penile venous surgery may provide an encouraging solution to impotent patients with veno-occlusive dysfunction who are non-responders to sildenafil.
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Affiliation(s)
- Hsien-Sheng Wen
- Microsurgical Potency Reconstruction and Research Center, Taiwan Adventist Hospital, Taipei Medical University, Taipei, Taiwan
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Hsieh CH, Wang CJ, Hsu GL, Chen SC, Ling PY, Wang T, Fong TH, Tseng GF. Penile veins play a pivotal role in erection: the haemodynamic evidence. ACTA ACUST UNITED AC 2005; 28:88-92. [PMID: 15811069 DOI: 10.1111/j.1365-2605.2005.00497.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although penile venous surgery has almost been abandoned and the venous factor eliminated as a contributing factor to erectile dysfunction, new concepts of erection-related veins has recently been described and reported in literature. We sought to conduct a haemodynamic study on human cadavers in order to elucidate to what extent penile veins act in erection, and to explore the possible role of erection-related veins as an important contributor to impotence. From November 2002 to December 2003, seven fresh human cadavers of men who had no sexual activity for at least 6 months prior to death, and in whom the penis was intact were used for this study. Infusion cavernosometry was carried out with an induction flow of 150 mL/min before and after the erection-related veins were removed. A rigid erection was attained in all subjects, lasting significantly longer (p = 0.043) after removal of erection-related veins. Similarly, there were significant differences in the maintenance flow (p = 0.043), T(max) (p = 0.043), V(max) (p = 0.043), and pressure loss (p = 0.043). In cadaveric penises, a rigid erection could be maintained in spite of the fact that the low flow rate of 21 mL/min is much lower than the average arterial perfusion rate observed in cases of arterial insufficiency. We therefore concluded that penile veins may play a significant role in attaining sufficient erection, and further research is required to study this possible clinical implication.
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Affiliation(s)
- Cheng-Hsing Hsieh
- Microsurgical Potency Reconstruction and Research Center, Taiwan Adventist Hospital, 424 Pa-Te Road, Sec. 2, Taipei, Taiwan.
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Walsh T, Tran K, Berger R, Wessells H. Traumatic intracorporal septal avulsion resulting in cavernous veno-occlusive dysfunction. Int J Impot Res 2004; 17:295-6. [PMID: 15538393 DOI: 10.1038/sj.ijir.3901289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- T Walsh
- Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA.
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Cakan M, Yalçinkaya F, Demirel F, Ozgünay T, Altuğ U. Is dorsale penile vein ligation (dpvl) still a treatment option in veno-occlusive dysfunction? Int Urol Nephrol 2004; 36:381-7. [PMID: 15783111 DOI: 10.1007/s11255-004-0934-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the long-term results of the DPVL for the treatment of venous impotence. PATIENTS AND METHODS The long term results of DPVL in 134 patients were interviewed. The mean age was 39.2 (range 21-72). Power color doppler imaging, pharmacocavernography/dynamic cavernosometry were performed. Postoperatively, all the patients were controlled in the 6th month, first year and, if possible, once a year. The mean follow-up was 54.8 (14-76) months. Postoperative outcomes were classified into three groups: complete spontaneous erection (CR), response to pharmacotherapy (PR) or no satisfactory improvement (NR). RESULTS The short-term success in the 6th month according to above mentioned was 38.8%, 18.6% and 42.5%; and in the first year was 19.4%, 14.9% and 65.6% respectively. The result in 35 patients whose follow-up was at least 5 years (mean 67 months) was 11.4%, 14.3% and 74.3% respectively. Positive prognostic factors were preoperative age <40, duration of erectile dysfunction <2 years, non-smoker patients, non neurogenic disease and distal disease. With all these parameters present, long-term success (CR, PR) rose from 33.6% to 55.9% (P < 0.001). CONCLUSIONS Long-term success for unselected patients undergoing DPVL is disappointing; however, careful patient selection significantly improves long-term results.
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Affiliation(s)
- M Cakan
- Department of Urology, SSK Dişkapi Training Hospital
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Martínez Portillo FJ, Jünemann KP, Sohn M. [Surgical therapy of erectile dysfunction. Current status]. Urologe A 2003; 42:1337-44. [PMID: 14569382 DOI: 10.1007/s00120-003-0419-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the light of the current domination of oral pharmacotherapy for the treatment of erectile dysfunction, the aim of this paper is to give a critical and up-to-date overview of the possibilities of surgical therapy. We evaluate possible therapy options such as penile vein surgery, arterial revascularisation surgery and penile prosthetics surgery. Today, vein surgery has faded into total insignificance due to the efficiency of oral and intracavernous therapeutics, and as a result of the pathomechanism of cavernoveinous insufficiency and the disappointing long-term results published in the literature. A similar fate has been met by penile revascularisation surgery, which today is performed only in a very limited number patients with strict selection criteria such as age and exclusion of diabetes mellitus. Thus, aside from pharmacotherapy, penile prosthetics is the only surgical therapy option maintaining its significance as a cure for erectile dysfunction. There are convincing long-term results with a high degree of patient and partner satisfaction, high patient acceptance and a good functional durability of the mostly three-part hydraulic implants.
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Abstract
Arterial revascularization and venous ligation procedures have been introduced within the past 2 decades. Each procedure has in common with the other the fact that initial applications of the operations were widespread among the population of men with vasculogenic erectile dysfunction. In each case, disappointing long-term results led to more limited use of surgery targeting specific groups that clearly would benefit from the procedures. The wider application of these procedures in vasculogenic erectile dysfunction is not supported by the available results. The Clinical Guidelines Panel of the American Urological Association supported this view in 1996 after a meta-analysis of literature reports and declared that venous and arterial surgery was not justified in routine use, especially in patients with arteriosclerosis. Further studies are likely to refine patient selection but are unlikely to expand the therapeutic use of these procedures.
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Affiliation(s)
- D S Rao
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
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Popken G, Katzenwadel A, Wetterauer U. Long-term results of dorsal penile vein ligation for symptomatic treatment of erectile dysfunction. Andrologia 2000; 31 Suppl 1:77-82. [PMID: 10643523 DOI: 10.1111/j.1439-0272.1999.tb01454.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
About 20% of patients with erectile dysfunction do not react to intracavernous pharmacological treatment (SKAT) because of a cavernous leak. The first attempt to treat venous insufficiency goes back as far as the beginning of the century. Ligature and resection of the superficial and deep veins of the penis (DPVL) were performed in 122 patients (nonresponders to SKAT with a maintenance flow of less than 40 ml min-1). Twenty-four patients suffered from primary dysfunction and 98 from secondary dysfunction. The average age of the patients was 49 years, and the average duration of the preoperative erectile dysfunction 4.4 years. Postoperative follow-up was carried out for 70 months. In 98% of the patients, cavernosography revealed a dorsal leak. Twenty-six per cent had ectopic veins, 38% a leakage through the crural veins and 24% a glandular or spongiosal shunt. After the 70-month follow-up, only 14% of the 122 patients were able to achieve an adequate spontaneous erection and 19% also responded to SKAT. Depending upon the time elapsed since the operation, the rate of spontaneous reaction was reduced. It was found that younger patients with a short history of erectile dysfunction, no arterial cofactor, a maintenance flow of less than 100 ml min-1 and a severe dorsal leakage from a DPVL were the most likely to benefit from this procedure. Since degeneration of smooth muscle cells of the cavernosa is in most patients the cause of the venous leakage, penis vein surgery is to be regarded as symptomatic treatment.
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Affiliation(s)
- G Popken
- Department of Urology, University Hospital, Freiburg, Germany
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SASSO F, GULINO G, WEIR J, VIGGIANO A, ALCINI E. PATIENT SELECTION CRITERIA IN THE SURGICAL TREATMENT OF VENO-OCCLUSIVE DYSFUNCTION. J Urol 1999. [DOI: 10.1016/s0022-5347(01)61614-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- F. SASSO
- From the Department of Urology, Catholic University of the Sacred Heart, Rome, Italy
| | - G. GULINO
- From the Department of Urology, Catholic University of the Sacred Heart, Rome, Italy
| | - J. WEIR
- From the Department of Urology, Catholic University of the Sacred Heart, Rome, Italy
| | - A.M. VIGGIANO
- From the Department of Urology, Catholic University of the Sacred Heart, Rome, Italy
| | - E. ALCINI
- From the Department of Urology, Catholic University of the Sacred Heart, Rome, Italy
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Jarow JP, DeFranzo AJ. Long-Term Results of Arterial Bypass Surgery for Impotence Secondary to Segmental Vascular Disease. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65678-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jonathan P. Jarow
- From the Departments of Urology and Plastic Surgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Anthony J. DeFranzo
- From the Departments of Urology and Plastic Surgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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