Progressive fibrosis in the corpora cavernosa after radical prostatectomy probably results from denervation and/or an ischemic process, which is caused in turn by the ligation of anomalous pudendal artery branches or of venous plexuses that drain to or from the corpora cavernosa. Fibrosis and the subsequent loss in elasticity and function of erectile tissue probably together cause erectile dysfunction.

BackgroundOver the past years laser technology has played a predominant role in prostate surgery, for the treatment of benign prostate hypertrophy (BPH). Various laser devices have been introduced in clinical practice, showing good results in terms of complications and urodynamic outcomes efficacy compared with TURP and Open Prostatectomy.In this study we describe the efficacy and the safety profile of a novel laser technique, ThuLEP (Thulium Laser Enucleation of Prostate) that permits a complete anatomical endoscopic enucleation of prostatic adenoma independently to prostate size.Methods148 patients with a mean age of 68.2 years were enrolled between September 2009 and March 2012 (36 months), and treated for BPH with ThuLEP. Every patient was evaluated at base line according to: Digital Rectal Examination (DRE), prostate volume, Post-Voided volume (PVR), International Prostate Symptoms Score (I-PSS), International Index of Erectile Function-5 (IIEF-5), Quality of Life (QoL), PSA values, urine analysis and urine culture, uroflowmetry. The same evaluation was conducted after a 12 month follow-up. ThuLEP was performed by 2 expert surgeons.ResultsOur data showed a better post-operative outcome in terms of catheter removal, blood loss, TURP syndrome, clot retention and residual tissue compared to large series of TURP and OP. Only 1.3% of patients had bladder wall injury during morcellation. I-PSS, Qmax, Prostate Volume, QoL and PVR showed a highly significant improvement at 12 month follow-up in comparison to preoperative assessment.ConclusionThuLEP represent an innovative option in patients with BPH. It is a size independent surgical endoscopic technique and it can be considered the real alternative, at this time, to TURP and even more to Open Prostatectomy for large prostate, with a complete removal of adenoma and with a low complication rate.

Peyronie's disease, the etiology of which remains unknown, is characterized by a focal or multifocal disorder of penile tunica albuginea. An excessive collagen deposition gives rise to the formation of the plaque, which is fibrotic first and then becomes calcific. Typical symptoms of the disease are painful erection, pathological bending of the erect penis and impotence at the more advanced stages (43% of the cases). There is evidence that the tunica albuginea has a fundamental role in the erection mechanism. We evaluated the tunica albuginea of patients suffering from Peyronie's disease, with or without impotence, and found progressive disorders of the microstructure in areas that were not affected by fibrocalcific formations. There was a significant decrease (p < 0.0001) of elastic fiber concentration (55.05 +/- 23.83 per high power field) in patients with Peyronie's disease compared to the concentration in the tunica albuginea of a control group (128.50 +/- 11.79 per high power field). Moreover, when the elastic fiber concentration in the tunica albuginea of patients Peyronie's disease and normal erection (71.36 +/- 12.00 per high power field) was compared to the concentration in the tunica albuginea of those with Peyronie's disease and impotence (33.14 +/- 4.84 per high power field) a significant difference was noted (p < 0.0001).

The primary goal in the management strategy of a patient with ED would be to determine its etiology and cure it when possible, and not just to treat the symptoms alone. One of the new therapeutic strategies is the use of low intensity extracorporeal shockwave (LISW) therapy. The mechanism of shockwave therapy is not completely clear. It is suggested that LISW induces neovascularization and improvement of cavernosal arterial flow which can lead to an improvement of erectile function by releasing NO, VEGF and PCNA.Materials and Methods:31 patients between February and June 2013 with mild to severe ED and non-Phosphodiesterase 5 inhibitors responders were enrolled. Patients underwent four weekly treatment sessions. During each session 3600 shocks at 0.09mJ/ mm2 were given, 900 shocks at each anatomical area (right and left corpus cavernosum, right and left crus). Improvement of the erectile function was evaluated using the International Index of Erectile Function (IIEF-EF), the Sexual Encounter Profile (SEP) diaries (SEP-Questions 2 and 3) and Global Assessment Questions (GAQ-Q1 and GAQ-Q2).Results:At 3-month follow-up IIEF-EF scores improved from 16.54±6.35 at baseline to 21.03±6.38. Patients answering ‘yes’ to the SEP-Q2 elevated from 61% to 89% and from 32% to 62% in the SEP-Q3. A statistically significant improvement was reported to the Global Assessment Questions (GAQ-Q1 and GAQ-Q2).Conclusion:In conclusion, we can affirm that LISW is a confirmed therapeutic approach to erectile dysfunction that definitely needs more long-term trials to be clarified and further verified.

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Aim: To evaluate whether a dose of 50 mg preserved the architecture of the corpora cavernosa biopsy in man. Methods: 21 patients (54–70 years old) who underwent radical prostatectomy for prostate cancer were treated with sildenafil citrate (50 mg, 3 times a week for 2 months) soon after surgery. They underwent cavernous biopsy before surgery and after 2 months of sildenafil treatment. Biopsy tissues were fixed in formalin, stained with Masson’s trichrome method, and evaluated with the Eureka Interface system with a per-area analysis, and elastic fibers were counted on 10–12 fields (×400) of five serial sections. Results: Two months after surgery the percent of connective tissue in cavernosa samples in all patients did not differ from that before surgery, being between 30 and 40% in the per-area analysis. Similarly, the elastic fiber count did not differ significantly before and after surgery. Conclusions: Sildenafil prevented the progression of fibrosis in prostatectomized patients. Its efficacy seems to result from an antiproliferative effect exerted on fibroblasts.

IntroductionWe studied the possible correlation between age, testosterone deficiency, cavernosal fibrosis and erectile dysfunction (ED).Methods47 patients with ED were enrolled between September 2010 and October 2011. IIEF-EF score, NPTR test using the Rigiscan method, total and free testosterone levels, and cavernosum biopsy were carried out on all patients. Patients aged 65 or over were defined as Old Age (OA) while patients under 65 were defined Young age (YA). The strength of the relationships found was estimated by Odds Ratio.Results74% of patients with values of over 52% collagen fibers in the corpora cavernosa were found to have organic ED. A significant difference was found in age, percentage of collagen fibers, testosterone levels between patients with Positive Rigiscan (PR) and Negative Rigiscan (NR). Hypotestosteronaemia increased the risk of ED with PR (OR: 21.4, 95% CI: 20.2-22.6) and in both young age patients (OR: 4.3, 95% CI: 2.4-6.2) and old age patients (OR: 15.5, 95% CI: 13.4-17.6). Moreover cavernosal fibrosis increased the risk of ED with PR in both young age patients (OR: 8.2, 95% CI: 6.4-10.0 and old age patients (OR: 24.6, 95% CI: 20.8-28.4).ConclusionsThis study demonstrates a strong association among age, testosterone deficiency, cavernosal fibrosis and ED with PR. Age, testosterone deficiency and cavernosal fibrosis are potentially correctable factors of cavernosal fibrosis and organic ED. Further, prospective studies are needed to evaluate if testosterone treatment, alone or in association with PDE5 inhibitors, may lower the risk of cavernosal fibrosis or decrease the severity the fibrosis in ED patients.

The tunica albuginea (TA) of the penis is thought to play a major role in the erection mechanism. It functions by compressing the subalbugineae venulae, which promotes the slower venous flow during erection, and provides a fibrous frame to give an inextensible support for the vessels and nerves. It acts as the inextensible enclosing structure which contains the erectile tissue and gives the erect penis its shape. The functions of the TA result from its structure, consisting for the most part of collagenic and elastic fibers. This study investigated, with the aid of scanning electron microscopy (SEM), the microarchitecture of the TA and the spatial relation of its fibers in ten impotent patients and in six control subjects with normal erectile function. The arrangement of elastic fibers in the TA seems to account for their function, which is to prevent the overstretching of collagenic fibers during maximum intracavernous pressure. In impotent patients, a reduction in the elastic fibers in the TA appears to produce disorders in the arrangement of the collagenic fibers. These alterations in the architecture of the TA in impotent patients can give rise top erection disorders.