1/17. Dramatic improvement of penile venous leakage upon testosterone administration. A case report and review of literature. The main effect of testosterone was long-time assumed to be on sexual interest and, indirectly, on erectile function. Newer insights demonstrate that testosterone deficiency impairs the anatomical, ultrastructural, biological and physiological/functional substrate of penile erection, which can be, at least in part, restored by normalization of plasma testosterone levels. This is a report on a 56-year-old man suffering from diabetes mellitus type II and metabolic syndrome, who had complaints of a severe erectile dysfunction because of venous leakage, confirmed by pharmaco-cavernosography. He was also testosterone deficient (1.8 ng ml(-1)). Upon testosterone administration his erectile function improved dramatically. Repeated cavernosography no longer showed venous leakage. ( info) |
| BACKGROUND: A 46-year-old man presented with erectile dysfunction following a blunt perineal injury sustained 1 year previously. Oral phosphodiesterase type 5 inhibitors failed to improve his erections. The remainder of the patient's history, physical examination and laboratory tests were unremarkable except for a moderate tenderness in the left perineum and some 'fullness' in the corpora cavernosa during physical examination. INVESTIGATION: physical examination, color duplex ultrasound of the penis and perineal area and Sexual health Index for men questionnaire. diagnosis: Non-ischemic priapism due to a ruptured left helicine artery, intermittent penile turgidity and erectile dysfunction. MANAGEMENT: Open suture ligation of the helicine artery and imbrication of the pseudocapsule. ( info) |
3/17. testosterone undecanoate restores erectile function in a subset of patients with venous leakage: a series of case reports. INTRODUCTION: androgens are critical for maintaining penile structure and function and androgen deficiency alters the function of the corporal veno-occlusive mechanism in animal models. However, there are limited research and data supporting this association in humans. methods: case reports of hypogonadal men (N = 12) with low plasma testosterone and moderate to severe erectile dysfunction are presented. Comorbidities varied, including diabetes mellitus type I or II, metabolic syndrome with possible related hypertension, dyslipidemia, or obesity. Oral phosphodiesterase type 5 (PDE5) inhibitor therapy did not improve erectile function. Each patient underwent baseline dynamic infusion pharmacocavernosometry and cavernosography revealing various degrees of corporal veno-occlusive dysfunction. The patients underwent treatment with 1,000 mg injectable testosterone undecanoate (Nebido) on day 1, followed by another injection after 6 weeks and every 3 months thereafter. Dynamic infusion pharmacocavernosography was repeated in all 12 patients after 3 months of treatment. RESULTS: Five of the 12 patients reported significant improvement in erectile function within 12-20 weeks of androgen treatment and are currently under follow-up. Compared with baseline pharmacocavernosography, repeat radiological studies in patients who reported improvement in erectile function did not show veins draining the corporal bodies. The patients who responded to androgens also noted improvement in sexual desire domain (International Index of Erectile Function [IIEF] scores increased from 4 /- 0.7 to 8 /- 0.3) and erectile function domain (IIEF scores increased from 6 /- 2 to 24 /- 1). CONCLUSION: The observations made in these limited series of case reports suggest that testosterone improved erectile function in hypogonadal patients by restoring veno-occlusive function. Prospective, multi-institutional, double-blind placebo-controlled trials in hypogonadal patients are indicated. ( info) |
4/17. Primary erectile dysfunction in a man with congenital isolation of the corpora cavernosa. We report on a 33-year-old man with primary erectile dysfunction, isolated cavernous bodies, corporeal veno-occlusive dysfunction, and hypoplastic cavernous arteries. To our knowledge, this is only the second reported case of absence of communication between the corpora cavernosa. ( info) |
| The authors present a unique case of impotence in a 65-year-old patient caused by an iatrogenic common femoral arteriovenous fistula. After surgical treatment of the fistula, there was a clear improvement of the erectile function. ( info) |
6/17. Laparoscopically assisted penile revascularization for vasculogenic impotence. Young patients with impotence and cavernous arterial insufficiency resulting from trauma-induced arterial occlusive disease are ideal candidates for microvascular arterial bypass surgery. To avoid the long abdominal incision required to harvest the inferior epigastric artery, a laparoscopic approach was used. We report a case of laparoscopically assisted penile revascularization for vasculogenic impotence. ( info) |
| Significant progress has been realized in the evaluation and treatment of erectile disorders during the past 15 years. The establishment of interdisciplinary teams and evolution of treatment centers have led to comprehensive, state-of-the-art evaluation and multiple innovative treatment options. Limitations in our knowledge, however, remain because age-related standards for diagnostic tests are not available. In some cases, we remain humble and uncertain about the validity of our diagnostic methods and our ability to offer proper treatments. The field is not standing still, however, and we expect that further refinements in evaluation techniques based on new findings in physiology and fresh psychological and medical approaches will make erectile dysfunction more efficiently and effectively treatable. ( info) |
8/17. Fracture of corpus cavernosum following penile venous surgery. A case report. A rare complication of fracture of the corpus cavernosum following penile venous surgery is described here. Problems of diagnosis and management are briefly outlined. ( info) |
9/17. Venous shunting as a complication to penile revascularization--a case report. As a serious complication to arterial penile revascularisation arterio-venous shunting was observed in a 60 years old male. The patient suffered bilateral obstruction of his pudendal arteries. Following revascularization using the left inferior epigastric artery he obtained good pulsation in the penis but no return of sexual function. Instead his general condition deteriorated. A follow-up angiogram revealed shunting of the contrast from the epigastric artery, via the penis, to the venous system. Venous ligation was carried out. The patient's general condition returned to normal status and he can now obtain rigid erections. Reconstructive arterial surgery for erectile dysfunction should never be carried out unless venous leak has been ruled out as a complicating factor. ( info) |
10/17. vacuum erection associated impotence and Peyronie's disease. PURPOSE: Use of a nonmedical, catalogue type vacuum erection device resulted in a case of vacuum induced vasculogenic impotence and Peyronie's disease. MATERIALS AND methods: A 66-year-old potent man used a nonmedical vacuum erection device (cylinder plus a hand pump without a pressure-release valve and a doughnut-shaped ring at the base without tension bands) after having achieved a spontaneous rigid erection. The resultant excessive overinflation of the penis was followed by dorsal curvature, diminished rigidity and decreased erectile maintenance. RESULTS: physical examination revealed a dorsal mid shaft Peyronie's plaque. Nocturnal penile tumescence testing and office injection testing were abnormal and demonstrated partial, short-lived, dorsally curved erections. Dynamic pharmaco-cavernosometry and pharmaco-cavernosography established vasculogenic impotence with site-specific crural (unrelated to the Peyronie's plaque) veno-occlusive dysfunction and dorsal penile curvature. CONCLUSIONS: vacuum erection devices create pulling forces on the penis. We estimate that the pulling forces in this case were prohibitively high (approximately 29 pounds) due to absence of a pressure-release valve and to the preexistent erection at vacuum application. These intense pulling forces are hypothesized to have damaged the tunica in the mid shaft (Peyronie's disease) and the crus (veno-occlusive dysfunction), the latter being the site of attachment of the corpora to the ischiopubic ramus and a most likely location for high magnitude pulling forces to exert an abnormal injury effect. The patient underwent a Nesbit plication procedure and presently performs self-injection for satisfactory sexual activity. ( info) |