The vascular and neurogenic factors associated with erectile dysfunction in patients after pelvic fractures

ABSTRACT Erectile dysfunction (ED) is a common complication of pelvic fractures. To identify the vascular and neurogenic factors associated with ED, 120 patients admitted with ED after traumatic pelvic fracture between January 2009 and June 2013 were enrolled in this study. All patients answered the International Index of Erectile Function (IIEF-5) questionnaire. Nocturnal penile tumescence (NPT) testing confirmed the occurrence of ED in 96 (80%) patients on whom penile duplex ultrasound and neurophysiological testing were further performed. Of these ED patients 29 (30%) were demonstrated only with vascular abnormality, 41 (42.7%) were detected only with neural abnormality, 26 (27.1%) revealed mixed abnormalities. Of the 55 patients (29+26) with vascular problems, 7 patients (12.7%) with abnormal arterial response to intracavernous injection of Bimix (15mg papaverine and 1mg phentolamine), 31 (56.4%) with corporal veno-occlusive dysfunction and 17 (30.9%) had both problems. Of the 67 (41+26) patients with abnormal neurophysiological outcomes, 51 (76.1%) with abnormal bulbocavernosus reflex (BCR), 20 (29.9%) with pathological pudendal nerve evoked potentials (PDEPs) and 25 (37.3%) with abnormal posterior tibial somatosensory nerve evoked potentials (PTSSEPs). Our observation indicated that neurogenic factors are important for the generation of ED in patients with pelvic fracture; venous impotence is more common than arteriogenic ED.

Preoperative corporal biopsy as a predictor of postoperative results in venoocclusive erectile dysfunction

Our aim was to investigate the association of corporeal cavernosal pathology with venoocclusive erectile dysfunction [ED] and whether preoperative corporeal biopsy can help predict postoperative results. Thirty-six patients with venoocclusive ED underwent corporeal cavernosal biopsy and venous ligation. Preoperative assessment included complete physical examination, international index of erectile dysfunction [IIEF] scoring, nocturnal penile tumescence, penile Doppler ultrasonography, cavernosography, and, if needed, cavernosometry. Three months postoperatively, all patient parameters were reevaluated and compared with the preoperative results. Biopsy results of 43 patients with penile fracture were used for controls. The mean age of the patients with ED was 32.1 +/- 8.6 years. The IIEF score and peak systolic velocity of the cavernosal artery in the patients did not differ postoperatively. The mean end diastolic velocity, however, decreased from 11.0 cm/s to 5.1 cm/s [P=.023]. Only 2 patients had satisfactory penile rigidity after venous ligation. Pathologically, 23 patients had a slight decrease of cavernosal smooth muscle cells, while in 9 patients, the cavernosal smooth muscles were markedly decreased and replaced by collagen fibers. Four patients had normal histologies, and all responded either partially or completely to surgical therapy. In the control group, 41 of 43 patients had normal histologies, and 2 had a slight decrease of smooth muscle cell mass. Decreased cavernosal smooth muscle mass may impair erectile function. Its association with venoocclusive ED may be a poor prognostic factor of the outcome of surgical therapy. For the preoperative evaluation of patients, we propose cavernosal biopsy

Anatomia radiológica dos corpos cavernosos e sistema venoso peniano / Cavernosum corpus radiologycal anatomy and penian venous system

Estudou-se o comportamento das veias dorsais profundas do pênis, com o auxílio da técnica de cavernosonografia modificada proposta, utilizando-se constraste iodado. Analisou-se 98 pacientes submetidos a contraste iodado. Analisou-se 98 pacientes submetidos a esta técnica, visando observar o comportamento anatômico da veia dorsal profunda do pênis e o comprometimento da disfunção erétil por fuga venosa. Constatou-se a ocorrência de varizes com fuga venosa bilateral em 11,3 por cento dos casos e varizes unilaterais com fuga venosa à esquerda em 68,4 por cento dos casos. Estes achados sugerem o elevado nível de comprometimento do ramo esquerdo da veia dorsal profunda do pênis nos casos de etiologia de disfunção por fuga venosa