Epidemiology regarding penile prosthetic surgery / 亚洲男科学杂志(英文版)

With the onset of a metabolic syndrome epidemic and the increasing life expectancy, erectile dysfunction (ED) has become a more common condition. As incidence and prevalence increase, the medical field is focused on providing more appropriate therapies. It is common knowledge that ED is a chronic condition that is also associated with a myriad of other disorders. Conditions such as aging, diabetes mellitus, hypertension, obesity, prostatic hypertrophy, and prostate cancer, among others, have a direct implication on the onset and progression of ED. Characterization and recognition of risk factors may help clinicians recognize and properly treat patients suffering from ED. One of the most reliable treatments for ED is penile prosthetic surgery. Since the introduction of the penile prosthesis (PP) in the early seventies, this surgical procedure has improved the lives of thousands of men, with reliable and satisfactory results. The aim of this review article is to characterize the epidemiology of men undergoing penile prosthetic surgery, with a discussion about the most common conditions involved in the development of ED, and that ultimately drive patients into electing to undergo PP placement.

Dynamic infusion cavernosometry and cavernosography for classifying venous erectile dysfunction and its significance for individual treatment / 中华医学杂志(英文版)

BACKGROUND@#The precise pathophysiology of venous erectile dysfunction (VED) was still unclear. Dynamic infusion cavernosometry and cavernosography (DICC) was the gold standard approach for the diagnoses of VED. However, a standard operative procedure of DICC was needed and it was unclear whether DICC could show promise in accurate assessment and treatment of VED. The aim of this study was to establish an optimized operation process of DICC and evaluate the efficacy of DICC in the diagnoses and therapy of VED.@*METHODS@#One hundred and forty-seven VED patients identified by the color doppler duplex ultrasonography (CDDU) were included. Then the method of DICC was adopted to assess the severity of VED and all patients were divided into 4 groups, including (1) non-VED; (2) mild VED; (3) moderate VED and (4) severe VED. All patients received the treatment of psychotherapy. Drug therapy, the intervention embolism of corpus cavernosum and the implantation of penile prosthesis were applied if psychotherapy was ineffective for patients. The international index of erectile function (IIEF-5) scores of patients were collected and compared before and after treatment.@*RESULTS@#IIEF-5 score of non-VED group after psychotherapy (19.35 ± 3.59) and drug therapy (23.31 ± 0.75) was higher than that before psychotherapy (15.30 ± 2.72, t = -4.31, P  0.05). IIEF-5 score of severe VED group was increased under the treatment of implantation of penile prosthesis (23.25 ± 0.71) compared with that before treatment (8.00 ± 0.39, t = -53.25, P < 0.05).@*CONCLUSION@#DICC was a valid diagnostic tool that could identify patients with VED. And DICC had great effect on the diagnosis and individual therapy for patients with VED in varying degrees. Moreover, the manipulation of DICC needed uniform standards.

Cavernosal artery peak systolic velocity among normal adults in Abuja, Nigeria: A Baseline parameter for sonographic diagnosis of vasculogenic erectile dysfunction

Background: Erectile dysfunction is consistent inability to achieve and maintain erection of sufficient rigidity for satisfactory sexual performance. It is well known that the hemodynamic function of the penis correlates well with the peak systolic velocity (PSV) of the cavernosal artery (CA) which is the most reliable, sensitive, and objective parameter used in evaluating the state of the erectile tissues of the penis. This study was aimed at establishing the normal CA PSV in this environment, as it may differ from the values among Americans, Caucasians, and Asians. Materials and Methods: The study was conducted between July 2015 and January 2017, at the Department of Radiology, Federal Medical Centre, Abuja. Twenty-nine consecutive patients referred by the urologist to the radiology department of the aforementioned institution for penile ultrasound were evaluated using triplex Doppler sonography with high-frequency linear array transducer. The penile scan was done before and after intracavernosal injection of 10­20 µg prostaglandin E1. The waveforms of CAs were obtained alternately using the angle of inclination ≤60°, and the PSV of the CA was documented at 5-min interval, from 5 to 40 min. Results: PSV of CA varied between 26 and 104.4 cm/s (mean: 46.72 ± 16.21) among the entire research participants. No significant discrepancy was noted between PSV of the right and left cavernosal arteries. The PSV had a strong positive relationship with age (P = 0.002), with the highest values found among those ≤30 years. Conclusion: The mean PSV of cavernosal arteries established in this study is not significantly different from the values obtained among Americans, Caucasians, and Asians, indicating that racial difference has no effect on this important sonographic variable

Cavernosopatía Traumática Aguda (CTA) trauma peneano en un grupo de 38 pacientes en un consultorio de medicina sexual durante 20 años de experiencia (1998-2018) / Acute Traumatic Cavernosopathy Penile Trauma in a Group of 38 Patients in a Sexual Medicine Clinic during 20 Years of Experience (1998-2018) Juan Fernando Uribe A

Introducción El trauma de pene tiene una variedad de presentaciones, no siempre de origen sexual con diversas implicaciones anatómicas y funcionales para él. Objetivo Describir los hallazgos en un grupo de pacientes de "Cavernosopatía traumática aguda" (CTA), desde el punto de vista clínico y ecográfico y sus desenlaces. Métodos Se realizó un estudio retrospectivo de un grupo de 38 pacientes que consultaron por CTA en un período de 20 años (1998-2018) en una consulta de medicina sexual en Medellín-Colombia. La condición para ser incluidos, era el antecedente en el tiempo de un trauma agudo y mayor del pene. Se evaluaron el tipo de trauma y variables relacionadas (crack audible, hematoma, fractura albugínea, ruptura del ligamento suspensorio, necesidad de cirugía); hallazgos clínicos (curvaturas, escotaduras, acortamiento); hallazgos ecográficos (Fibrosis peneana, fugas venosas) y otros desenlaces (disfunción eréctil). El estudio contó con la aprobación del comité de ética en investigación del HPTU. Resultados Se estudiaron 38 pacientes con diagnóstico de CTA. Edad de consulta: 42 y edad del trauma 38,7 años, promedio. Trauma sexual (TS): 23 pacientes (60,5%), No sexual (TNS): 15 pacientes (39,4%). Hematomas: 22 (57,8%); fractura albugínea: 16 (42,1%); ruptura del ligamento suspensorio: 2 (5,2%); curvatura secundaria: 14 (36,8%); nódulos palpables: 13 (34,2%); acortamiento: 11 (28,9%); crack audible: 13 (34,2%); algún grado de disfunción eréctil: 26 (68,4%); necesidad de cirugía urgente: 6 (15,78%). En los 31 (81,5%) pacientes que tuvieron una ECO peneana como parte de su estudio tenemos, hallazgo de fibrosis: 25/31 (80,6%); fugas venosas cavernosas: 5/31 (16,1%) e hipervascularización 10/31 (32,2%). Conclusiones La Cavernosopatía traumática aguda (CTA) es una denominación adecuada para el síndrome que desencadena un trauma peneano agudo, que puede incluir secuelas como fibrosis peneana (hasta el 80%), curvaturas secundarias (hasta el 38%), acortamiento, fugas venosas y disfunción eréctil (hasta 70% de los casos). Entre 6/10 de esos traumas, son de índole sexual y el resto son un grupo variopinto de traumas (automovilísticos, deportivos, quemaduras, ataques de animales)

Introduction Penis trauma has a variety of presentations, not always of sexual origin with various anatomical and functional implications for the penis. ObjectiveTo describe the findings in a group of patients of "acute traumatic Cavernosophaty", from the clinical and echographics point of view and their outcomes. Methods A retrospective study of a group of 38 patients who consulted by CTA in a period of 20 years (1998-2018) in a sexual medicine clinic in Medellin, Colombia, was conducted. The condition to be included was the antecedent in time of an acute and major trauma of the penis. The type of trauma and related variables were evaluated (audible crack, hematoma, albuginea fracture, rupture of the suspensory ligament, need for surgery); clinical findings (curvatures, notches, shortening); ultrasound findings (penile fibrosis, venous leaks) and other outcomes (erectile dysfunction). The study was approved by the research ethics committee of the HPTU. Results Thirty-eight patients with diagnosis of CTA were studied. Age of consultation: 42 and age of the trauma 38.7 years, average. Sexual trauma (TS): 23 patients (60.5%), Non-sexual (TNS): 15 patients (39.4%). Haematoma: 22 (57.8%); albugineal fracture: 16 (42.1%); rupture of the suspensory ligament: 2 (5.2%); secondary curvature: 14 (36.8%); palpable nodules: 13 (34.2%); shortening: 11 (28.9%); audible crack: 13 (34.2%); some degree of erectile dysfunction: 26 (68.4%); need for urgent surgery: 6 (15.78%). In the 31 (81.5%) patients who had a penile ECO as part of their study: fibrosis finding: 25/31 (80.6%); venous cavernous leaks: 5/31 (16.1%) and hypervascularization 10/31 (32.2%). Conclusions Acute traumatic cavernosopathy is an appropriate name for the syndrome that triggers a greater and acute penile trauma, which can include sequelae such as penile fibrosis (up to 80%), secondary curvatures (up to 38%), shortening, venous leaks and erectile dysfunction (up to 70% of cases). 6/10 of these traumas are of a sexual nature and the rest are a motley group of traumas (car, sports, burns, animal attacks).

Evaluation of the Causes of Erectile Dysfunction in Patients Undergoing Penile Doppler Ultrasonography in Pakistan

PURPOSE: In patients with erectile dysfunction, it is important to differentiate psychogenic from organic causes. Penile Doppler ultrasonography is a relatively inexpensive and minimally invasive tool for this purpose. This study was conducted to evaluate the causes of erectile dysfunction in an adult male population, using penile Doppler ultrasonography. MATERIALS AND METHODS: A retrospective study was conducted in a single center. All patients who presented with complaints of erectile dysfunction and underwent penile Doppler ultrasonography between July 2014 and June 2016 were included in this study. All examinations were performed using GE Voluson S6 and GE Logiq P5 devices. Following baseline scans, an intracavernosal injection of 20 µg of prostaglandin E1 was given. Peak systolic and end diastolic velocities were measured in each cavernosal artery. Patients with a peak systolic velocity of 5 cm/s was considered to indicate venous incompetence. RESULTS: Out of 97 patients (mean age, 37.09±11.59 years; range, 19~69 years), 50 patients (51.5%) had normal findings, 24 patients (24.7%) had arterial insufficiency, 15 patients (15.5%) had a venous leak, and 8 patients (8.2%) patients had arterial insufficiency with a venous leak. Psychogenic erectile dysfunction was significantly higher among patients aged ≤40 years, while arterial insufficiency with or without a venous leak was significantly higher among patients aged >40 years (p=0.022). CONCLUSIONS: A majority of the studied individuals demonstrated no organic cause of erectile dysfunction, thus confirming a high prevalence of the psychogenic etiology, particularly in relatively young individuals.

Contrast-enhanced ultrasonography in the diagnosis of venous erectile dysfunction / 中华男科学杂志

Objective@#To investigate the effect and safety of contrast-enhanced ultrasonography (CEUS) in the diagnosis of venous erectile dysfunction (VED).@*METHODS@#From June 2015 to March 2016, 43 ED patients underwent corpus cavernography, of whom 23 were diagnosed with and the other 20 without corpus cavernosal venous leakage (CCVL). All the patients received intracorporal injection of a vasoactive drug and CEUS.@*RESULTS@#Of the 23 patients with CCVL, 21 were confirmed by CEUS, including 12 cases of double venous leakage, 2 cases of single venous leakage, 5 cases of crural venous leakage, and 2 cases of the mixed type, while the other 2 showed no CCVL on CEUS. Of the 20 patients with CCVL, 2 presented CCVL on CEUS.@*CONCLUSIONS@#CEUS has the advantages of accuracy, safety, and less invasiveness in the diagnosis of VED.

Endovascular therapy for arteriogenic erectile dysfunction / 中华男科学杂志

Erectile dysfunction (ED) is a common male condition, which is closely related with cardiovascular diseases. With the increasing incidence of cardiovascular events, arteriogenic ED (AED) is becoming more prevalent in recent years. Despite the variety of therapies for ED, no effective treatment has been found for this arteriogenic type. Based on the experience in the successful treatment of cardiovascular diseases by endovascular therapy, some scholars are carrying out clinical researches on this therapy for AED, which has shed some new light on its management. This review outlines recent advances in the studies of endovascular therapy for AED.

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.

Dynamic infusion cavernosometry and cavernosography for the diagnosis and classification of venous erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the procedures of dynamic infusion cavernosometry and cavernosography (DICC) and their application in the diagnosis and classification of venous erectile dysfunction (VED).</p><p><b>METHODS</b>This study included 103 ED patients, aged 20 to 43 years, highly suspected of VED, with disease courses of 4 months to 6 years. DICC was performed and analyses were made on the results, especially the parameters of flow-to-maintain (FTM) and pressure decay (PD) in the corpus cavernosum.</p><p><b>RESULTS</b>Based on the parameters of FTM and PD, 21 of the patients were normal, 5 were suspected of VED, 39 had mild VED, 25 had moderate VED, and 13 had severe VED. Penile subcutaneous hematoma was found in 4 of the patients, all recovered after 3 to 5 days, with no other complications.</p><p><b>CONCLUSION</b>DICC is a reliable, safe and minimally invasive method for the diagnosis and classification of VED.</p>

Pressure Ulcer Scale for Healing no acompanhamento da cicatrização em pacientes idosos com úlcera de perna / Pressure Ulcer Scale for Healing in monitoring of wound healing in elderly patients with leg ulcer

Introdução: Este trabalho objetiva descrever a evolução da cicatrização e o tratamento realizado em pacientes com úlceras de perna no ambulatório de feridas, utilizando o instrumento Pressure Ulcer Scale for Healing - PUSH. Métodos: Trata-se de pesquisa na modalidade estudo de caso, realizada com quatro pacientes. Os dados foram colhidos em um Hospital Estadual do interior de São Paulo, nos anos 2009 e 2010, por meio de fotografias digitais e da escala de evolução de feridas Pressure Ulcer Scale for Healing. Os itens avaliados são: área da ferida, quantidade de exsudato e aparência do leito da ferida. Resultados: Na primeira avaliação, o primeiro caso apresentava escore total 16; o segundo e o terceiro casos, escore total 13; e o quarto caso, escore total 15. Na segunda avaliação, o primeiro caso apresentava escore total 13; o segundo, escore total 7; o terceiro, escore total 6; e o quarto, escore total 11. Na última avaliação, o primeiro caso apresentava escore total 4 e no segundo, terceiro e quarto casos, o escore total foi zero. A aplicação da Escala Pressure Ulcer Scale for Healing na avaliação dos 4 pacientes deste estudo possibilitou aos enfermeiros realizar a prescrição da cobertura ideal para o processo cicatricial da lesão. Conclusão: Concluiu-se que o referido instrumento facilita sobremaneira a atuação da enfermagem na avaliação e na escolha da cobertura ideal para a promoção da epitelização da lesão, uma vez que tem por base a avaliação de parâmetros importantes durante o processo dinâmico do cuidar de feridas.

Introduction: This work describes the evolution of wound healing and outpatient treatment of patients with leg ulcers using the Pressure Ulcer Scale for Healing (PUSH) tool. Method: This research was performed as a case study with four patients. The data were gathered at a State Hospital in the countryside of the State of São Paulo from 2009 to 2010 through digital photographs and the PUSH wound evolution scale. The wound area, amount of exudate and appearance of the wound bed were assessed. Results: In the first assessment, the first case presented with a total score of 16; the second and third cases, 13; and the fourth case, 15. In the second assessment, the first case presented with a total score of 13; the second, 7; the third, 6; and the fourth, 11. In the last assessment, the first case presented a total score of 4, and the second, third and fourth cases, 0. The application of the PUSH to assess the four patients in this study allowed nurses to perform the optimal wound dressing prescribed for the healing process. Conclusion: It was concluded that the aforementioned tool greatly facilitates nursing performance in assessing and choosing the optimal dressing to promote the epithelialization of the wound, which is based on the assessment of important parameters during the dynamic process of wound care.

Sympathetic Skin Response in Patients with Vascular Erectile Dysfunction

PURPOSE: We aimed to investigate the utility of sympathetic skin response (SSR) test for evaluating vasculogenic erectile dysfunction (ED) which is the most common type of impotence. MATERIALS AND METHODS: Men in the age group of 28 to 60 years and suffering from vasculogenic ED, as confirmed by a papaverin test and color Doppler sonography, at least for 6 months referred from our university urology department were included. We used the International Index of Erectile Function (IIEF-5) for grading severity of dysfunction and recorded the SSR of every patient from the median, tibial, and dorsal nerves of the penis. One-way analysis of variance (ANOVA), independent t-test and Pearson's correlation coefficient were used for comparing quantitative variables, and Fisher's Exact test was used for comparing qualitative variables. The Mann-Whitney U Test and the Kruskal-Wallis test were performed for analysis of data that were not normally distributed. A p value of less than 0.05 was considered significant. RESULTS: Forty-two patients were recruited for the study. We found a strong statistical relationship between the IIEF score and the pathologic SSR registered from every mentioned nerve. Patients with abnormal SSR had more severe ED according to IIEF score (p<0.001). In addition, the IIEF score had a significantcorrelation with diabetes mellitus and cardiovascular disease (t-test; p<0.05). CONCLUSIONS: Our results confirmed the presence of autonomic dysfunction in patients with vasculogenic impotence via an SSR test. We suggest evaluating the efficacy of the SSR test in patients with vascular impotence for treatment response monitoring in future studies.

Can the Mean Platelet Volume Be a Risk Factor for Vasculogenic Erectile Dysfunction?

PURPOSE: The mean platelet volume (MPV) is a marker of the platelet activity and is reported to increase in vascular diseases. We aimed to investigate the association between MPV and vasculogenic erectile dysfunction (ED). MATERIALS AND METHODS: MPV and platelet (PLT) levels were measured in 50 cases of ED and 40 healthy controls. The diagnosis of vasculogenic ED was based on a detailed sexual history, physical examination, laboratory assessment, and color Doppler ultrasonography. The results are given as mean+/-standard deviation of the mean. RESULTS: The mean ages of the patient and the control groups were 53.70+/-12.39 years (range 24~77 years) and 53.85+/-9.5 years (range 30~73 years), respectively (p=0.947). The MPV and PLT values were significantly higher in the patients with ED than those of the controls (7.49+/-1.4), (6.85+/-1.2), (262.97+/-68), (252.89+/-82) respectively, p0.05), and there was no correlation between MPV and either age of patients (p=0.905) or duration of ED (p=0.583). CONCLUSIONS: The platelet count and MPV was detected to be increased in patients with vasculogenic ED. This finding suggests a role for platelets in the pathogenesis of vascular complications and that the MPV would be useful in monitoring disease progression.

Smoking impairs endothelial function in ED patients / 中华男科学杂志

<p><b>OBJECTIVE</b>To determine whether smoking affects the endothelial function of young ED patients with no cardiovascular disease.</p><p><b>METHODS</b>This study included 69 ED patients (21 smokers and 48 non-smokers) and 16 age-matched normal healthy controls. All underwent measurement of brachial artery flow-mediated vasodilation (FMD) and examinations of blood pressure, cholesterol, triglycerides and glucose.</p><p><b>RESULTS</b>Brachial artery FMD was remarkably decreased in the ED patients, even more significantly in the smokers ([6.0 +/- 0.8]%) than in the non-smokers ([9.7 +/- 2.5]%) (P < 0.05), as compared with that in the normal healthy controls ([14.0 +/- 2. 5]%, P < 0.05).</p><p><b>CONCLUSION</b>Endothelial function is impaired in ED patients, and is further damaged by smoking.</p>

Protection of penile vascular endothelial function: a new strategy for the management of erectile dysfunction / 中华男科学杂志

Erectile function is a typical neurovascular process. Penile vascular endothelial dysfunction is indicated to be one of the important mechanisms of ED. Protective agents to improve penile vascular endothelial function show significant benefits to erectile function by decreasing the damage of oxidative stress and optimizing the related mediators. The protection of penile vascular endothelial function is a new approach to the treatment of ED.

Correlação da resposta clínica à vardenafila em dois regimes terapêuticos com parâmetros vasculares e escore de risco cardiovascular em hipertensos com disfunção erétil vasculogênica / Correlation of clinical response of vardenafil in two therapeutic regimens with vascular parameters and cardiovascular risk score in hypertensive patients with vasculogenic erectile dysfunction

A disfunção erétil (DE) tem alta prevalência entre hipertensos e tem sido considerada marcdor precoce de risco cardiovascular. A presença e gravidade da DE bem como a resposta clínica aos inibidores da fosfodiesterase tipo 5 (PDES) parecem depender da biodisponibilidade do óxido nítrico (NO) endotelial e da extensão da doença aterosclerótica. O objetivo deste estudo foi avaliar a resposta clínica da vardenafila usada em dois regimes terapêuticos em hipertensos com DE vasculogênica e sem doença cardiovascular maior, correlacionando a gravidade da DE e a eficácia da vardenafila com dados antropométricos, laboratoriais, escore de risco cardiovascular e parâmetros vasculares funcionais e estruturais. A resposta clínica à vardenafila nos dois regimes foi avaliada conforme o percentual de respostas positivas à questão 3 do Perfil do Encontro Sexual (PES3). Os parâmetros vasculares considerados foram a espessura médio-intimal (EMI) da carótida comum, a dilatação mediada pelo fluxo (DMF) da artéria braquial e a dilatação nitrato-mediada (DNM). Foram incluídos 100 homens hipertensos com idade entre 50 e 70 anos, sendo 74 portadores de DE vasculogênica e 26 com função erétil normal que serviram de grupo controle. Nos pacientes com DE, o índice de massa corporal, relação cintura-quadril, EMI da carótida, níveis séricos de triglicerídeos, colesterol total e LDL foram significativamente maiores que no grupo controle. Após o uso de vardenafila on demand (fase 1), os pacientes com mais de 50% de respostas positivas ao PES3 ou 50% de respostas afirmativas e um incremento de 6 pontos ou mais em relação ao Índice Internacional de Função Erétil (IIEF-FE) basal e/ou resposta positiva a Questão de Avaliação Global (QAG), foram considerados respondedores. O escore do IIEF-FE basal se correlacionou negativamente com a EMI da carótida (r=-0,48, P<0,001) e com o escore de Framingham (r=-0,41, P<0,001) no grupo com DE. Houve forte correlação positiva entre a resposta clínica...

Erectile dysfunction (ED) is a high prevalent disease in hypertensive subjects and has been considered an early cardiovascular risk marker. ED's presence and severity, as well as clinical response to phosfodiesterase type 5 (PDES5) inhibitors, vary according to nitric oxide (NO) availability and atherosclerosis extension. We investigated whether vasculogenic ED severity and clinical response to vardenafil used on demand or continuously were associated with structural and functional vascular changes in patients with uncomplicated hypertension. Our main efficacy criterion was per patient percentage of positive answers on Sexual Encounter Profile question 3(SEP3). Vascular parameters considered were intima-media thickness (IMT), flow-mediated dilation (FMD) on brachial artery and nitrate-mediated dilation. A total of 100 hypertensive men aging between 50 and 70 years were included. Among these patients, 74 had vasculogenic ED and 26 presented normal erectile function according to erectile domain of International Index of Erectile Function (IIEF-EF). Among those with ED, body mass index, waist-rip ratio, carotid IMT, triglycerides, total cholesterol and LDL-cholesterol were significantly higher than controls. After vardenafil on demand usage during phase 1, patients with more than 50% of positive answers on SEP3 or 50% and more than 6 points on IIEF basal score or positive answer to global evaliation question were considered "responders". IIEF basal score correlated inversely with carotid IMT (r=-0.48, P<0.001) and with Framingham risk score (r=-0.41, P<0.001) in ED group. Clinical response to vardenafil strongly correlated with FMD (r= 0.70, P<0.001), except among diabetics. "Non responders" (n=35) on phase 1 were included on phase 2 when, after randomization, they received vardenafil 10 mg nightly or placebo during five weeks. Open vardenafil on demand were allowed on hour before sexual intercourse, and 38.8% of active group improved and became responders...

Penile revascularization for erectile dysfunction: a systematic review and meta-analysis of effectiveness and complications

Patients with arteriogenic erectile dysfunction [ED] caused by traumatic localized arterial lesions can be treated successfully by penile revascularization [PR] surgery. We aimed to determine the subjective and objective outcomes of PR surgery in patients with arteriogenic ED. We searched for relevant publications released up to May 2008 in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Biological Abstracts. The citation lists of review articles and included trials were also searched. Studies on different operative techniques of PR for men with ED due to traumatic penile arterial lesions were selected. Data on participants' characteristics, study quality, population, intervention, cure, and adverse effects were collected and analyzed. There were 25 studies on comparison of the PR operative techniques. Concerning subjective cure, men younger than 30 years old had better results than older ones [odds ratio, 3.7; 95% confidence interval, 2.2 to 6.4; P=.001]. Venous leak [odds ratio, 1.8; 95% confidence interval, 1.2 to 2.6] and history of smoking [odds ratio, 3.4; 95% confidence interval, 2.2 to 5.6] influenced success rate. Inconsistent measurements of outcomes limited the findings, and none of the studies were randomized controlled trials. Traumatic patients with arteriogenic ED might benefit from PR. Patient selection is vital for a successful outcome. Variations in penile vascular anatomy are also likely to be important when individualizing penile revascularization. In a limited number of highly selected individuals, PR can be successful for the long-term. Randomized controlled trials examining PR techniques are warranted

Cavernous body reduction in four patients with erectile dysfunction due to insufficient venous occlusion and a deficit of elastic fibers in the tunica albugínea

INTRODUCTION: The corpora cavernosa are cylindrical vessels containing fluid under pressure. Thus, if cavernous wall resistance decreases, the radius increases and internal pressure decreases (LaPlace's law). We reasoned that if we decrease the corpus cavernosum radius, by excising a strip from each tunica albuginea, intracavernous pressure would increase during erection. MATERIALS AND METHODS: We treated with this procedure, four patients (mean age 41.5) with long-standing erectile dysfunction due to veno-occlusive dysfunction, non-responders to phosphodiesterase-5 inhibitors and intracavernous PGE1 injection. RESULTS: Two months post-surgery, intracavernous PGE1 (40 mcg) induced a satisfactory erection in two patients and a 45 percent and 58 percent tumescence in the other two. PGE1 responders also responded to 100 mg sildenafil. After 100 mg sildenafil and 20 mg tadalafil, the two non-responders had erections that enabled penetration but were short lasting. CONCLUSION: The procedure described could be more effective than cavernous revascularization operations. The results seem to confirm the mathematical assumptions.

Vascular factors in the pathogenesis of diabetic erectile dysfunction / 中华男科学杂志

Diabetic erectile dysfunction (DED) is a multifactor syndrome, which involves vascular disease, neuropathy, metabolic control, nutrition, endocrine disorders, psychogenic factors, and anti-diabetes drugs. Among all these factors, vascular disease plays a very important role. In the development of diabetic vasculopathy, some vasomotion factors and growth factors undergo conspicuous changes, which may be significantly correlated with the development of diabetic erectile dysfunction.

IIEF-5 cannot be used as a tool for differential diagnosis of vasculogenic erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the 5-item version of the international index of erectile function (IIEF-5) as a method to differentiate the causes of vasculogenic erectile dysfunction (ED).</p><p><b>METHODS</b>In all, 103 ED patients (mean age 46.8 +/- 18.7) were reviewed by IIEF-5. Penile blood flow was also assessed in each patient after an intracavernosal injection (ICI) and audio-visual sex stimulation by duplex Doppler ultrasonography. The 99mTc-(113m)In dual radioisotope test was performed to confirm specific vascular causes in the vasculogenic ED cases. Kruskal-Wallis TEST was employed to compare the scores of IIEF-5 with the results of ICI, duplex Doppler ultrasonography and the 99mTC-(113m)In dual radioisotope test.</p><p><b>RESULTS</b>Of the total number of ED cases, 37 (37/103, 35.9%) were nonvasculogenic, 18 (18/103, 17.5%) arteriogenic, 35 (35/103, 34.0%) venogenic and 13 (13/103, 12.6%) combined vasculogenic. There was no significant difference in the IIEF-5 scores either between the vasculogenic group and the non-vasculogenic one (P = 0.253) or among different groups of the vasculogenic ED patients.</p><p><b>CONCLUSION</b>IIEF-5 cannot be used as a tool for differential diagnosis of vasculogenic ED, or to compare its specific vascular causes, nor can the scores of IIEF-5 reflect penile vascular conditions.</p>

Plastía de pene tipo peri-cavernoplastía para el manejo de la disfunción eréctil / Penis Peri-Cavernoplasty for Erectile Disfunction Treatment

La cirugía venosa del pene para tratamiento de la disfunción eréctil (D.E.) se hizo muy popular en la década de los '80, pero los pobres resultados a largo plazo hicieron que fuera dejada de lado; resultados mejorados asociados a criterios estrictos de selección han permitido un renovado interés por esta alternativa terapéutica de la D.E. Presentamos nuestra experiencia con la técnica de pericavernoplastía con cinta de Dacron descrita por Rossi: tres de los nueve pacientes operados presentaban erecciones útiles al control a los doce meses (33 por ciento); probablemente este bajo resultado fue más relacionada con la selección de los pacientes que con falla en la técnica quirúrgica. Creemos que puede ser una alternativa válida para servicios de salud sin acceso a prótesis de pene.

Penile venous surgery was very popular in the ’80 ies, but unsatisfactory long-term results reduced this indication for the therapy of erectile dysfunction. Better selection criteria have been associated to an increased success rate and renewed interest in venous surgery. We made an experience with the Rossi’s pericavernoplasty technique: only 33% of the patients in our group reported a good erection in the longterm follow up at 12 months. This low rate is probably more related to a poor selection of the patients than a failure of the surgical technique. We consider this could be a good option for health services with no access for penile prosthesis.