Mechanisms of Venous Leakage: A Prospective Clinicopathological Correlation of Corporeal Function and Structure

Abstract

The pathophysiology of structurally based corporeal veno-occlusive dysfunction is related to elevated corporeal connective tissue content. Based on our data and those in the literature corporeal fibrosis is hypothesized to develop secondary to abnormalities in the regulation of normal collagen synthesis and degradation, most likely associated with adverse influences of chronic ischemia.

Androgen depletion in humans leads to cavernous tissue reorganization and upregulation of Sirt1–eNOS axis

“…Negative control was performed by primary antibody omission (d) hemodynamic events: increased arterial inflow, sinusoidal SM relaxation, and decreased venous outflow. Thus, the mechanical properties of erectile tissue are strictly dependent on the integrity of its structure (Moreland 2000;Nehra et al 1996).…”

“…They provide substantial evidence that long-standing androgen deprivation, either physiologically, as it occurs in aging, or following pharmacological treatment, leads to cavernous tissue remodeling that results in a replacement of SM cells by fibroblasts, increase in collagen deposition, and reduction of the SM-to-CT ratio. The consequent change in fibroelastic properties of penile tissue compromises the compliance and hemodynamics, results in corporeal veno-occlusive dysfunction (Nehra et al 1996) and decreased capacity of sinuses to fill with blood, and produces an effective erection (Ferrer et al 2010).…”

“…Briefly, dilation of the resistance arterial bed of the penis favors blood flow and entrapment in the corpus cavernosum (CC), a combined effect of expansion of the lacunar spaces by relaxation of the trabecular smooth muscle (SM) and compression of the draining venules. The efficiency of this process strongly depends on the integrity of the trabecular SM as corpora expansion is related directly to its content and inversely to that of connective tissue (CT) (Luo et al 2007;Nehra et al 1996;Wespes et al 1991). In fact, cavernous SM cell loss or functional impairment is the etiological basis of erectile dysfunction (ED) in many patients, since muscular tonus regulates the stages of erection, which cannot be achieved by vascular mechanisms alone (Wespes 2002).…”

Urologic Complications of Diabetes

“…As a result of diabetes, progressive replacement of cavernosal smooth muscle by fibrosis may lead to complete erectile failure (53). Effective surgical interventions in such cases are limited to penile implants.…”

Is there a role of hypoxemia in penile fibrosis

“…7±11 In a prospective study of men undergoing penile prosthesis insertion, we have found a direct correlation between erectile function and the ratio of trabecular smooth muscle to total erectile tissue. 2 Erectile function was de®ned by experimentally determined parameters of¯ow to maintain erection, resistance to ®lling, and pressure decay using dynamic infusion corpus cavernosography/cavernosometry (DICC) 12 ow-to-maintain values (50 ±120 ml/min) and substantial cavernous leakage. Similar relationships were found when out¯ow resistance and pressure decay were correlated with percent trabecular smooth muscle.…”