Venous Surgery in Erectile Dysfunction

Gilbert, P.; Sparwasser, C.; Beckert, R; Treiber, Uwe; Pust, R

doi:10.1159/000282394

Cited by 18 publications

(5 citation statements)

References 10 publications

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“…In particular, Doppler interrogation of CSC can be useful in patients with high flow priapism, since these vessels can represent collaterals feeding the cavernosal fistula. Moreover, it has been demonstrated that veno-occlusive dysfunction is usually due to a pathology of the cavernous tissue [13,14,15,16,17,18] which cannot relax, rather than to pathological blood leakage through the outflow vascular pathways; however, blood leakage could exist, for instance, in pathological conditions such as severe Peyronie disease, or in posttraumatic albugineal scars, where the tunica albuginea cannot distend and trigger the veno-occlusive mechanism. Doppler investigation of CSC could be useful in these patients because these vessels are possible leakage pathways.…”

Section: Resultsmentioning

confidence: 99%

Color Doppler appearance of penile cavernosal–spongiosal communications in patients with normal and impaired erection

et al. 2002

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Our objective was to investigate prevalence and Doppler characteristics of penile cavernosal-spongiosal communications (CSC). These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Sixty-one consecutive patients underwent penile color Doppler US. Waveform changes in CSC were evaluated in comparison with changes in the cavernosal artery. Eighteen of 61 patients had normal erection, 17 of 61 had arterial insufficiency, and 26 of 61 had veno-occlusive dysfunction. Resistance index (RI) in CSC was significantly lower than in cavernosal arteries in all patients and increased during phases 1-2 (positive diastolic flow). Peak systolic velocity (PSV) in CSC was significantly higher in the patients with veno-occlusive dysfunction. During cavernosal phase 4 (diastolic flow reversal) CSC of patients with normal erection or with arterial insufficiency disappeared, underwent markedly reduced diastolic flow, or had systolic flow inversion. Conversely, low resistance flow was appreciable in CSC of patients with veno-occlusive dysfunction who reached phase 4. During phase 5 (systolic peak reduction) all CSC disappeared. Color Doppler US allows evaluation of CSC both in patients with normal and impaired erection.

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Section: Resultsmentioning

confidence: 99%

Color Doppler appearance of penile cavernosal–spongiosal communications in patients with normal and impaired erection

et al. 2002

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“…21 Vascular surgery consisted in both arterial reconstructive surgery 22 or venous surgery such as Selective Vein Ligation (SVL) of veins identified as incontinent. 23 Penile prostheses used in this study were inflatable self-contained prostheses. 24 Finally, commercial vacuum constriction devices were used.…”

Section: Discussionmentioning

confidence: 99%

Sexual inactivity results in reversible reduction of LH bioavailability

et al. 2002

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We have recently documented significantly reduced serum testosterone (T) levels in patients with erectile dysfunction (ED). To understand the mechanism of this hypotestosteronemia, which was independent of the etiology of ED, and its reversibility only in patients in whom a variety of nonhormonal therapies restored sexual activity, we measured serum luteinizing hormone (LH) in the same cohort of ED patients (n ¼ 83; 70% organic, 30% nonorganic). Both immunoreactive LH (I-LH) and bioactive LH (B-LH) were measured at entry and 3 months after therapy. Based on outcome (ie number of successful attempts of intercourse per month), patients were categorized as full responders (namely, at least eight attempts; n ¼ 51), partial responders (at least one attempt; n ¼ 20) and non-responders (n ¼ 16). Compared to 30 healthy men with no ED, baseline B-LH (mean AE s.d.) in the 83 patients was decreased (13.6 AE 5.5 vs 31.7 AE 6.9 IU=L, P < 0.001), in the face of a slightly increased, but in the normal range, I-LH (5.3 AE 1.8 vs 3.4 AE 0.9 IU=L, P < 0.001); consequently, the B=I LH ratio was decreased (3.6 AE 3.9 vs 9.7 AE 3.3, P < 0.001). Similar to our previous observation for serum T, the three outcome groups did not differ significantly for any of these three parameters at baseline. However, outcome groups differed after therapy. Bioactivity of LH increased markedly in full responders (pre-therapy ¼ 13.7 AE 5.3, post-therapy ¼ 22.6 AE 5.4, P < 0.001), modestly in partial responders (14.8 AE 6.9 vs 17.2 AE 7.0, P < 0.05) but remained unchanged in non-responders (11.2 AE 2.2 vs 12.2 AE 5.1). The corresponding changes went in the opposite direction for I-LH (5.2 AE 1.7 vs 2.6 AE 5.4, P < 0.001; 5.4 AE 2.2 vs 4.0 AE 1.7, P < 0.05; 5.6 AE 1.2 vs 5.0 AE 1.2, respectively), and in the same direction as B-LH for the B=I ratio (3.7 AE 4.1 vs 11.8 AE 7.8, P < 0.001; 4.2 AE 4.3 vs 5.8 AE 4.2, P < 0.05; 2.1 AE 0.7 vs 2.6 AE 1.3, respectively). We hypothesize that the hypotestosteronemia of ED patients is due to impaired bioactivity of LH. This reduced bioactivity is reversible, provided that resumption of sexual activity is achieved regardless of the therapeutic modality. Because biopotency of pituitary hormones is controlled by the hypothalamus, LH hypoactivity should be due to the hypothalamic functional damage associated to the psychological disturbances which unavoidably follow sexual inactivity.

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“…Kaplan (1974). Vascular surgery consisted of both arterial reconstructive surgery (Levine & Goldstein, 1990) or venous surgery such as Selective Vein Ligation (SVL) of veins identi®ed as incontinent (Gilbert et al, 1992). Penile prostheses used in this study were in¯atable self-contained prostheses (Petrou & Barret, 1990).…”

Section: Hormone Pro®le At Entrymentioning

confidence: 99%

Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone

et al. 1999

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The role of androgenic hormones in human sexuality, in the mechanism of erection and in the pathogenesis of impotence is under debate. While the use of testosterone is common in the clinical therapy of male erectile dysfunction, hypogonadism is a rare cause of impotence. We evaluated serum testosterone levels in men with erectile dysfunction resulting either from organic or non-organic causes before and after non-hormonal impotence therapy. Eighty-three consecutive cases of impotence (70% organic, 30% non-organic, vascular aetiology being the most frequent) were subjected to hormonal screening before and after various psychological, medical (prostaglandin E1, yohimbine) or mechanical therapies (vascular surgery, penile prostheses, vacuum devices). Thirty age-matched healthy men served as a control group. Compared to controls, patients with impotence resulting from both organic and non-organic causes showed reduced serum levels of both total testosterone (11.1 +/- 2.4 vs. 17.7 +/- 5.5 nmol/L) and free testosterone (56.2 +/- 22.9 vs. 79.4 +/- 27.0 pmol/L) (both p < 0.001). Irrespective of the different aetiologies and of the various impotence therapies, a dramatic increase in serum total and free testosterone levels (15.6 +/- 4.2 nmol/L and 73.8 +/- 22.5 pmol/L, respectively) was observed in patients who achieved normal sexual activity 3 months after commencing therapy (p < 0.001). On the contrary, serum testosterone levels did not change in patients in whom therapies were ineffective. Since the pre-therapy low testosterone levels were independent of the aetiology of impotence, we hypothesize that this hormonal pattern is related to the loss of sexual activity, as demonstrated by its normalization with the resumption of coital activity after different therapies. The corollary is that sexual activity may feed itself throughout the increase in testosterone levels.

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Venous Surgery in Erectile Dysfunction

Cited by 18 publications

References 10 publications

Color Doppler appearance of penile cavernosal–spongiosal communications in patients with normal and impaired erection

Color Doppler appearance of penile cavernosal–spongiosal communications in patients with normal and impaired erection

Sexual inactivity results in reversible reduction of LH bioavailability

Lack of sexual activity from erectile dysfunction is associated with a reversible reduction in serum testosterone

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