My views about the applied anatomy on the penis and the physiopathology of erection.

From 1964 till 1977 I had the opportunity to make a study on circa 300 cadaver-penises (ROMANIA). My goal was to begin the surgical treatment of the organic impotency. Parallel with the investigations in mortuo (Table I), I began the explorations in vivo: clinical, general; and especially: "local" exploration of the executive organ, the penis; the methods used are enumerated in table II. The aims were: a) the diagnosis and b) the possibility of surgical treatment of organic impotence. After 1977, in west Germany, I could continue only my clinical work; (diagnosis and surgery). Till now I examined circa 5000 men with or without potency troubles; I could perform circa 1900 operations, in the last 9 years almost only with penile implants. I developed my own patterns. In this way, I could discover in mortuo and then confirm in vivo: The importance of the penile structures for a true potency; I described a "virile morphogram of the penis" (table III). The frequency of the anatomical variations --New, unknown causes of organic impotence at the level of the penis. Thus I described as first in 1975 (in rumanian) the "leakage factor" of the corpora cavernosa; later I described the frequency of fibroses in the corpus cavernosum penis (CCP). I could demonstrate that "the fixed impotency", especially in ageing men, is almost always organic (somato-psychic). Permanently improving the surgical proceeding helped me to reduce to a minimum the always possible complications. For instance: in the last 9 years, in circa 1400 operations with penile implants I had no infection more. As a rule a surgical proceeding must succeed, if possible, "from the first and for ever". It is for that, the penile implants have the most important place in the treatment of organic impotence, (not only as "ultima ratio").

The hemodynamics of erection at the level of the penis and its local deterioration.

We have studied penile structure in 300 specimens from cadavers, 3,000 patients undergoing general physical examination and more than 700 patients operated on for organic impotence. Special attention has been focused on the closure mechanism of the corpora cavernosa during erection. Venous outlets of the corpora cavernosa normally are situated only on the distal third of the ventral penile surface. A firm, lasting erection requires a tight albuginea of the corpora cavernosa, with perfect closure of the venous outlets. During life use of the penis or, eventually, misuse by repeated long-lasting, firm erections (high pressure in the corpora cavernosa) results in deterioration of the tightness of the albuginea, especially when the albuginea is thin (25 per cent of the cases). We have found that a leakage factor of the corpora cavernosa is the most frequent cause of organic impotence in aging men.

[Protheses of the penis; 130 cases (author's transl)]. / Prothesierung des Penis (130 Fälle).

The authors report their experience (13 years) with circa 130 operations and over 300 exercises on corpse-penes. From 1966 till 1972 the authors used an unilateral device, with inconstant good results. 1972 to 1975: a bifurcated penile implant made from Teflon with better results, but without firm proximal footings; (76 patients). 1975 to 1977: 73 cases = 26 with the new developped penile implant with one-way articulation and 11 with modified Small-Carrion penile implants. These modern protheses can create a true "phallus" = 130 to 150 mm long. The implants with one-way articulation guarantee solid posterior footings (very important for immissus in vaginam). The technique with the 3 approaches (perineal, praesymphyseal and distal) is described. The presence of a rigidified big penis was no problem for the patients, as long as it can be bent at its base, painless and efficient = potentia satisfaciendi. In doubtful situations the indication for operation should be settled by a team of specialists.