The Rationale for Pharmacologic Cavernosography

Stief, Christian G.; Bénard, François; Diederichs, W.; Bosch, Ruud; Lue, Tom F.; Tanagho, Emil A.

doi:10.1016/s0022-5347(17)42127-6

Cited by 15 publications

(4 citation statements)

References 10 publications

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“…However, to date, these data have not been able to correlate with patients' ED diagnosis strongly. 26 All too often, penile response is suboptimal, leaving the clinician wondering whether the patient has severe arterial insufficiency, venous leakage or high degree of anxiety. While an anal probe capable of measuring vascular and muscular activity during sexual arousal is available, it is rarely used in research, especially in Asia, due to the stigma evoked.…”

Section: Methodsmentioning

confidence: 99%

The engineering analysis of bioheat equation and penile hemodynamic relationships in the diagnosis of erectile dysfunction: part I—theoretical study and mathematical modeling

Chia

2007

Int J Impot Res

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The extent to which skin surface bioheat perfusion predicts penile physiological response such as an erection has not been extensively investigated. A biomechanical engineering study was performed to compare bioheat distribution on penile skin surface resulting from an induced erection at steady state to examine the efficacy of such method as an adjunct tool for the diagnosis and classification of erectile dysfunction (ED) due to different etiology. We based our arguments on the principle that blood vessel activity and perfusion to corpus cavernosa at the erect state are almost always higher than that in the flaccid state. Our results showed that a difference of 0.1-0.3 1C can be observed and hence used to develop database of 'smart diagnosis' for ED using the machine artificial intelligence. It is anticipated that such basic research into blood flow is critical, as blood perfusion into corpus cavernosa is the most influential factor determining functional erectile quality contributing to successful coitus. Increased understanding of the hemodynamic response profile contributes toward optimal treatment and thus enables clinicians to adopt an appropriate management scheme for ED. IntroductionErectile dysfunction (ED) is the failure to develop and maintain erections of sufficient rigidity for penetrative sexual intercourse.1 In all cultures, the issue of ED has always been linked with masculinity; having the false believe that the capacity of a strong erection is a symbolic of strong men. The frequency of ED and its related research have not been well investigated, partially due to its sensitivity of information and respondents giving unreliable replies. The diagnosis of ED has also been held back by the lack of objective definition of the problems, and sometimes due to the reluctance of physicians and patients in carrying out certain conversations. However, the cause of ED are frequently multiple, with psychological, neurological, endocrinological, vascular, traumatic and chemical components being described. The precise role of environmental and lifestyle factors such as smoking, stress, hypertension and diabetes mellitus in the development of ED has been proposed as potential risk factors. The complexity of research in the area of sexual arousal of men is probably due to erectile function, which being a function of great evolutionary antiquity is very much subjected to erotic stimuli and can diminish over habituation. Experiments with animals have shown that rams introduced to fresh partners quickly restored the rates of intercourse compared with the male exposed to the same partner all the time. Rams introduced to the same partner have a much longer time to ejaculation compared with rams introduced to different partners at the same rate.2 Thus, ED, or many other sexual related diseases, are not always the failure of some biomechanical or biochemical process. The human sexual response is a complex, multifaceted phenomenon that is not completely, or nearly, understood by scientist or sexologist. To date, probabl...

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Section: Methodsmentioning

confidence: 99%

The engineering analysis of bioheat equation and penile hemodynamic relationships in the diagnosis of erectile dysfunction: part I—theoretical study and mathematical modeling

Chia

2007

Int J Impot Res

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“…Since adequate compression of the draining veins via the relaxed cavernosal sinoids is only achieved during increasing rigidity, nowadays the investigation is always performed with the use of vasoactive substances and is then classified as pharmacocavernosography (Stief et al 1988). High doses of the vasoactive substances are necessary because the indication for pharmacocavernosography is a negative result in vasoactive testing.…”

Section: Evaluation Ofvenous Drainagementioning

confidence: 99%

Disorders of Sperm Deposition

Ahlen¹,

Hertle²

2001

Andrology

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“…Patients requiring a higher dose of cither substance are candidates for pharmacocavernosography. This investigation, w hich may be complemented by cavernosometry, is of paramount importance in diagnosing venous leakage [5][6][7][8]. Under normal conditions the venous outflow of the cavernous bod ies subsides within 20 s once a complete artificial erection has been achieved w ith the help of intracavernosal injection of 10-20 pg pros taglandin Ei and subsequent filling of the corpora cavernosa with contrast medium ( fig.…”

Section: Diagnosticsmentioning

confidence: 99%

Venous Surgery in Erectile Dysfunction

Gilbert¹,

Sparwasser²,

Beckert³

et al. 1992

Urol Int

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We report here on our surgical experience with venous leakage of the cavernous bodies. Out of 159 patients operated on, 134 were availabe for long-term follow-up. Depending on the cavernosographic findings, one of three different surgical procedures was carried out: ligation of the deep dorsal vein of the penis, spongiosolysis, or ligation of the crura. 18% of the patients undergoing ligation of the deep dorsal vein, postoperatively attained spontaneous erections, while 35% needed adjuvant corpus cavernosum autoinjection therapy. Spongiosolysis gave a more favourable result: spontaneous erections in 30% and vasoactive drug-dependent erections in 35%. Crural ligation did not prove successful. No serious complications were encountered postoperatively. Our data suggest that venous surgery should only be offered to a selected group of patients comprising young impotent men with venous leakage, maybe in combination with arterial disease, and patients suffering from distal venous leakage. Old age, neurogenic disorders causing erectile dysfunction, and diabetes mellitus should represent exclusion criteria for venous surgery.

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The Rationale for Pharmacologic Cavernosography

Cited by 15 publications

References 10 publications

The engineering analysis of bioheat equation and penile hemodynamic relationships in the diagnosis of erectile dysfunction: part I—theoretical study and mathematical modeling

The engineering analysis of bioheat equation and penile hemodynamic relationships in the diagnosis of erectile dysfunction: part I—theoretical study and mathematical modeling

Disorders of Sperm Deposition

Venous Surgery in Erectile Dysfunction

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