Nuclear Medical Assessment of Penile Hemodynamics following Revascularization Surgery

Abstract

Variations of Hauri’s penile revascularization have been in clinical use since 1983. The hemodynamics of the so-called three-vessel anastomosis remain uncertain despite successful, clinically reproducible results. The goal of this study was to depict the increased perfusion of the erectile system of the penis following revascularization by means of the inferior epigastric artery. Ten mil-liliters of heparinized peripheral venous blood was drawn from 10 patients prior to surgery. The radioactively tagged erythrocytes (1 mCi ⁹⁹mTc) were reinjected via an additional incision in the donor vessel proximal to the anastomosis following completion of the three-vessel anastomosis and intracaver-nous injection of 20 µg PGE₁ Once again, blood was drawn during the tumescence phase from both a peripheral vein and the corpora cavernosa within the normal circulatory duration and compared to the original specimen. Eight of ten patients displayed evidence of primary reperfusion of the corpora cavernosa via the inferior epigastric artery as the donor vessel. Using strict indications, revascularization of the penis is an effective mode of therapy for arterial erectile dysfunction.

Arteriosclerosis of Penile Arteries: Histological Findings and Their Significance in the Treatment of Erectile Dysfunction

“…The function of the arteriovenous anastomosis is to assure continuous blood flow to prevent thrombosis of the shunt. The augmented blood flow in the dorsal artery results in better perfusion of the corpus cavernosum, as could be proven using radioactively labeled erythrocytes [4]. In clinical series dealing with revascularization [5,6], good results even in patients with arteriosclerosis are seen 1 year after surgery.…”

Penile Revascularization Surgery in Erectile Dysfunction

“…Among other things unsuitable methods should show that the goal of efficient perfusion of the cavernous bodies was not reached by revascularization [15]. Yet, improved designs using glucose perfusion [16] and 99 Tc-tagged erythrocytes [17] provided evidence that cavernous tissue undergoes increased arterial perfusion with our operative technique ( fig. 14, 15).…”

Penile perfusion and functional scintigraphy:

“…However, such microsurgical revascularization procedures offer the patient with ED the only possibility of regaining physiological erection and such operations are performed worldwide to that end. In parallel, repeated attempts have been made to confirm the haemodynamic efficacy of these revascularization methods, using animal experiments or intraoperative measurements in patients [ 17, 18].…”