On the pathogenesis of penile venous leakage: role of the tunica albuginea

Ahmed Shafik,Ismail Shafik,Olfat El Sibai,Ali A Shafik

doi:10.1186/1471-2490-7-14

Ahmed Shafik, Ismail Shafik + Show 2 more

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https://doi.org/10.1186/1471-2490-7-14

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Journal: BMC Urology	Publication Date: Sep 5, 2007
Citations: 53	License type: CC BY 2.0

Affiliation: Cairo University, Menoufia University

Abstract

BackgroundEtiology of venogenic erectile dysfunction is not exactly known. Various pathologic processes were accused but none proved entirely satisfactory. These include presence of large venous channels draining corpora cavernosa, Peyronie's disease, diabetes and structural alterations in fibroblastic components of trabeculae and cavernous smooth muscles. We investigated hypothesis that tunica albuginea atrophy with a resulting subluxation and redundancy effects venous leakage during erection.Methods18 patients (mean age 33.6 ± 2.8 SD years) with venogenic erectile dysfunction and 17 volunteers for control (mean age 31.7 ± 2.2 SD years) were studied. Intracorporal pressure was recorded in all subjects; tunica albuginea biopsies were taken from 18 patients and 9 controls and stained with hematoxylin and eosin and Masson's trichrome stains.ResultsIn flaccid phase intracorporal pressure recorded a mean of 11.8 ± 0.8 cm H2O for control subjects and for patients of 5.2 ± 0.6 cm, while during induced erection recorded 98.4 ± 6.2 and 5.9 ± 0.7 cmH2O, respectively. Microscopically, tunica albuginea of controls consisted of circularly-oriented collagen impregnated with elastic fibers. Tunica albuginea of patients showed degenerative and atrophic changes of collagen fibers; elastic fibers were scarce or absent.ConclusionStudy has shown that during erection intracorporal pressure of patients with venogenic erectile dysfunction was significantly lower than that of controls. Tunica albuginea collagen fibers exhibited degenerative and atrophic changes which presumably lead to tunica albuginea subluxation and floppiness. These tunica albuginea changes seem to explain cause of lowered intracorporal pressure which apparently results from loss of tunica albuginea veno-occlusive mechanism. Causes of tunica albuginea atrophic changes and subluxation need to be studied.

Highlights

Etiology of venogenic erectile dysfunction is not exactly known
The cause of veno-occlusive dysfunction is not exactly known. It may result from several possible pathophysiologic processes which include the presence of large venous channels draining the corpora cavernosa, Peyronie's disease, diabetes and structural alterations in the fibroelastic components of the trabeculae, cavernous smooth muscle and endothelium [4,5,6]
We hypothesized that the cause of venous leakage during erection is an atrophy of the tunica albuginea (TA) with a resulting TA subluxation and redundancy

Summary

Introduction

Various pathologic processes were accused but none proved entirely satisfactory These include presence of large venous channels draining corpora cavernosa, Peyronie's disease, diabetes and structural alterations in fibroblastic components of trabeculae and cavernous smooth muscles. The cause of veno-occlusive dysfunction is not exactly known It may result from several possible pathophysiologic processes which include the presence of large venous channels draining the corpora cavernosa, Peyronie's disease, diabetes and structural alterations in the fibroelastic components of the trabeculae, cavernous smooth muscle and endothelium [4,5,6]. The treatment of venogenic ED (VED) is penile veins ligation if the known less invasive measures such as intracavernous injection of vasodilators fail to induce adequate erection [7] It seems that these treatment modalities deal with a secondary effect rather than the primary etiological factor of the venogenic ED; the results of treatment are unsatisfactory [7].

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