11/17. Deep dorsal vein arterialization in arteriogenic impotence: use of the dorsal artery as a neoarterial source. Deep dorsal vein (DDV) arterialization has developed as a treatment option for patients with arteriogenic impotence, especially in situations where artery-to-artery bypass is not feasible. The inferior epigastric artery (IEA), harvested through a lower abdominal incision, has usually served as the neoarterial source. Using dynamic infusion cavernosometry and cavernosography (DICC) to evaluate arterial and venous erection factors and pudendal arteriography to define arterial anatomy, we have identified 16 patients with cavernosal artery (CA) obstruction and a normal dorsal artery (DA) to serve as the neoarterial source. All patients were less than 50 years old (mean 34.8 /- 8.6 years). During DICC, the gradient between systemic and CA systolic occlusion pressures averaged 38.7 mmHg. Two patients showed moderate and two minimal corporal veno-occlusive dysfunction (CVOD). From 1991-94, all 16 underwent microscopic DA-DDV arterialization. Four of these patients also underwent venous ligation procedures and three had IEA bypass to the other DA. With adequate follow-up in 15 men, the results for six are considered excellent or normal (40%); eight improved (53.3%) and one was unchanged. In the improved group are three men who did not respond adequately to maximum penile injection therapy before surgery but used small doses afterward with success. Of the three smokers in the series, two were improved and one unchanged. Excellent results were found in four of five men (80%) under age 30 but only one of five (20%) over age 40. Complications included two instances of penile shortening and one of glans hyperemia requiring reoperation. By avoiding an abdominal approach, operative times, morbidity and recovery were substantially shortened. This operative approach can provide an excellent treatment for nonsmokers with CA obstruction and a normal DA. ( info) |
12/17. Glans hyperemia after penile revascularization: a late complication following alpha-1-receptor blockade for benign prostatic hyperplasia. Surgical revascularization of the penile vessels is one treatment choice for patients with vasculogenic impotence. hyperemia of the glans is a rare but severe complication which usually occurs early. We report a patient who developed this complication more than 3.5 years after surgery following onset of medical treatment of benign prostatic hyperplasia with a vasodilating alpha 1-receptor blocker. ( info) |
13/17. Laparoscopic mobilization of the inferior epigastric artery for penile revascularization in vasculogenic impotence. A laparoscopic approach was used for penile revascularization in a patient with vasculogenic impotence to avoid the long abdominal incision which was traditionally required to harvest the inferior epigastric artery as a neoarterial source. Despite the time-consuming nature of laparoscopy, this procedure was as efficacious but less morbid and required less convalescence than open revascularization. Whether more patients may benefit from this procedure must be evaluated in further studies. ( info) |
14/17. Sexual health for the man at midlife: in-office workup. Normal physiologic changes occur with age that affect male sexuality. The etiology of these problems is often vascular but may be influenced by medications, neurologic conditions, or endocrinopathies, and/or iatrogenic factors. Penile sensitivity and erectile responses decline with age, and patients may present with concerns about ejaculatory disorders and erectile dysfunction. physicians need to know the pharmacologic, surgical, and educational solutions. Treatment modalities for erectile dysfunction include vacuum erection, devices, intracavernosal or intraurethral alprostadi injections, and penile implants. ( info) |
15/17. Laparoscopically assisted penile revascularization for vasculogenic impotence: 2 additional cases. PURPOSE: Microsurgical revascularization of the penis in vasculogenic impotence is an accepted surgical procedure in young men with a history of blunt pelvic or perineal trauma. Most penile revascularization techniques use the inferior epigastric artery in direct artery-to-artery revascularization or dorsal vein arterialization procedures. To obviate the wide pararectal incision laparoscopic mobilization of the inferior epigastric vessels has been recently proposed. We present 2 cases of successful laparoscopically assisted penile revascularization. MATERIALS AND methods: With the patient under general anesthesia the first trocar was inserted in the umbilical region and pneumoperitoneum was induced. Two other trocars were positioned laterally. As soon as the inferior epigastric vessels were accessed, dissection was initiated below the level of the arcuate line. The vessels were dissected cephalad en bloc to a point of bifurcation of the inferior epigastric artery above the umbilical level. The inferior epigastric pedicle was ligated with clips and transected at the cephalad edge of the dissection. It was then mobilized and tunneled through an infrapubic incision at the base of the penis for subsequent microvascular anastomosis with the penile vessels. RESULTS: The anastomosis was patent and hemostasis was satisfactory. operative time in the 2 cases was 4.3 and 5.2 hours, respectively. At 3 months both patients reported complete erections. CONCLUSIONS: Our experience confirms the extremely practical use of laparoscopy which, due to its magnification power, makes it possible to perform fast, accurate excision of the epigastric bundle. Moreover, a wide pararectal incision, which is a frequent cause of postoperative complications, is avoided. ( info) |
16/17. Primary erectile dysfunction in combination with congenital malformation of the cavernous bodies. Primary erectile dysfunction in combination with congenital malformation of the cavernous bodies has only rarely been reported. We report on 2 young patients with different congenital malformations. To our knowledge this is the first time partial aplasia of the distal part of the cavernous bodies is described, whilst complete isolation of the cavernous bodies in combination with veno-occlusive dysfunction has yet been described in 3 cases. After complete examination, including penile angiography and cavernosometry, a surgical correction with a fully satisfying result was achieved in the patient with distal aplasia. In case of isolated cavernous bodies with severe veno-occlusive dysfunction, the implantation of a penile prosthesis remains the treatment of choice. ( info) |
17/17. erectile dysfunction due to single vessel failure: diagnosis and surgical treatment. We report on the successful surgical treatment of venous single vessel disease in a patient presenting with erectile dysfunction. We stress the necessity of accurate diagnostic workup which enables the identification of rare cases that can be cured surgically. ( info) |