Cavernous Artery Research Articles

(006) GENITAL VASCULAR RESISTANCE AS A PREDICTOR OF CARDIOVASCULAR RISK ACCORDING TO THE ANALYSIS OF THE PROGETTO CUORE IN PREMENOPAUSAL WOMEN

Abstract Introduction Gender disparity persists in the relationship between sexual dysfunction and cardiovascular risk (CV). It is well- known that erectile dysfunction (ED) represents a sign of subclinical CV pathology and that alterations in color Doppler penile ultrasound parameters serve as predictive markers of major CV events. Female sexual dysfunction (FSD) is a complex condition that involves psychological and organic components, including the cardiovascular system, and affects the quality of life of over a third of women. However, despite its high prevalence, little attention has been paid to the vascular system responsible for blood supply to the female genital apparatus. In men, the hypothesis of penile artery size is a proposed pathophysiological mechanism to address the relationship between the onset of ED symptoms and cardiovascular disease. In recent years, it has also been highlighted that compromised genital vascularization may be a precursor to cardiovascular diseases in women. Objective Our ami gas to investigate the association between clitoral pulsatility index (PI), evaluated through Clitoral color Doppler ultrasound (CDU), and cardiometabolic risk factors in women referred to the Andrology, Women’s Endocrinology and Gender Incongruence Unit, Careggi University Hospital, Florence, Italy. Methods In an observational study, a total of 361 women with a mean age of 45.1 (±13.3) years were evaluated. All patients underwent a thorough medical history assessment, an evaluation of anthropometric parameters, blood sampling for measurement of metabolic and hormonal parameters and a Doppler ultrasound of the clitoral cavernous artery to measure the PI. Results 23.5% of the patients were overweight and 11.6% were obese, 16.3% had hypertension, and 18.6% had metabolic syndrome. In the multivariate analysis, after adjusting for age, the PI was positively correlated with body mass index (BMI) (ß=0.160, p=0.003) and waist circumference (ß=0.186, p=0.002). Furthermore, all women underwent cardiovascular risk assessment, as indicated by Progetto CUORE, assigning a score based on the presence of risk factors (blood pressure, cholesterol levels, smoking, diabetes, age, gender) to estimate the absolute global cardiovascular risk over the next 10 years. We observed that, particularly in women of reproductive age, the clitoral PI was positively correlated with the Progetto CUORE score (r=0.136, p=0.035). Conclusions Clitoral PI increases in relation to several cardiometabolic risk factors. It is therefore relevant to understand how common cardiometabolic alterations may influence vascular function in the female genital tract and whether treating these alterations leads to an improvement in clitoral ultrasound indices, especially in young premenopausal women. Disclosure No.

(141) Can a Nocturnal Penile Tumescence and Rigidity Test Detect Organic Aetiology of Erectile Dysfunction? A Peripheral and Penile Vascular Study

Abstract Introduction In the diagnostic workup of erectile dysfunction (ED) the Nocturnal Penile Tumescence and Rigidity test (NPTR) is being used less and less because of its inconvenience but also in part because of the intrinsic limits of this test. In particular, the NPTR has been considered very useful to diagnose psychogenic ED when it is positive (normal) but less informative when it is negative (pathological) because of the high incidence of false negatives. Other tests have been suggested to better diagnose an organic ED, especially the dynamic Penile Colour-Doppler Ultrasound (PCDU) to study the penile vascular response and detect a vasculogenic ED. Objective The purpose of the study was to explore the value of a pathological NPTR by investigating relationship between the NPTR result and the peripheral vascular health at the carotid, brachial and cavernous arteries. Methods We conducted an observational study involving patients with ED who had undergone a NPTR as part of their ED diagnostic workup. We assessed their peripheral vascular health through (1) the measurement of the intima-media thickness at the carotid arteries (cIMT), (2) the measurement of the flow-mediated dilation at the brachial artery (FMD), and (3) performing a PCDU. Results Globally, our patients presented with a normal cIMT, FMD and Peak Systolic Value (PSV) in the PCDU. The group with pathological NPTR were significantly older than patients with normal NPTR (55.6 vs 44.1 years, p=0.002), had a higher prevalence of hypertension (50.0 vs 6.8%, p=0.001), longer hypertension duration (8.0 vs 1.3 years, p=0.035), a higher prevalence of diabetes mellitus (42.9 vs 6.8%, p= 0.004), higher blood glucose (111 vs 92 mg/dl, p=0.004) and higher blood triglycerides levels (188 vs 96 mg/dl, p=0.002). Furthermore, they showed lower PSV (46.2 vs 71.0 cm/s, p=0.002) while we did not find significant differences as regards cIMT and FMD between the two groups. Interestingly, the prevalence of patients with pathological PSV (<35 cm/s) was higher among patients with a pathological NPTR but without reaching the statistical significance. However, when adopted an age-dependant cut-off described in the literature (PSV < age x 0.7 + 6.73) the difference between the two groups became significant (50.0 vs 11.4%, p=0.005). Finally, the correlation analysis showed a significant correlation between PSV and the cIMT (-0.352, ρ=0.009), the maximum number of events in the RPTR record (+0.344, ρ=0.012), and the mean tip tumescence (+0.303, ρ=0.036). When corrected for age, these associations lost their statistical significance. Conclusions This study demonstrates the diagnostic value of a pathological NPTR which suggests an organic aetiology of the ED and associates with pathological findings in the PCDU. Age appears to be one of the most important risk factors for ED, even when other risk factors are present. Finally, when using a PCDU to diagnose vasculogenic ED, a cut-off of 35 cm/s might be less sensitive than an age-dependent cut-off to detect early impairments of penile endothelial function. Disclosure No.

(159) Factors and Management Strategies for Addressing Reduced Glans Engorgement Following Inflatable Penile Prosthesis: A Scoping Review

Abstract Introduction Inflatable penile prosthesis (IPP) provides a reliable stiffness along the length of the penile shaft, yet patients may express dissatisfaction as it may still differ from their recollection of their previously normal erections. A common complaint is reduced engorgement of the glans penis, which can manifest as subjective reduction in penile length or the feeling of a cold insensitive glans. Patient factors often ensure a sound justification for this complaint, namely vasculogenic erectile dysfunction (ED) or their corporo-glandular morphology despite a well-sized and well-positioned implant. Objective In this study, we sought to identify factors that may contribute to reduced glans engorgement and possible management strategies. Methods Intervention: Any method of treating or avoiding reduced glans engorgement post-IPP. Population: Men undergoing IPP insertion or men with glans complaints post-operatively Inclusion Criteria: Articles published in English with full text available and objective outcome measures Search Strategy: Literature search was performed in June 2023 using Medline, PubMed, Embase and Scopus. PubMed search included both “Mesh” protocols and “free text” to capture the correct study population and intervention utilized. Review Type & Analysis: Although an initial systematic model was considered, a scoping model was ultimately selected due to the limited literature and inconsistent outcome measures. This approach aimed to identify gaps in knowledge and provide an overview of the existing literature, thus informing future studies in this area. The variability in outcome measures across studies prevented higher-powered analyses from being conducted. Results Initial search strategy retrieved 98 non-duplicate studies with 40 being selected for initial screening after applying inclusion criteria. Ultimately, a total of 7 articles were included and categorized by theme: Cavernous-sparing technique (1–3); Pharmacotherapy for post-IPP glans complaints (4–7) (Table 1 & 2). The cavernous-sparing technique described aims to limit disruption of cavernous tissue around the implanted cylinder. This was achieved by omitting dilatation and using Furlow directly for measurements, or by intraoperative intracavernosal (IC) prostaglandin followed by dilatation only with size 7 or 8 Hegar alone. In all studies that compared penile dimensions, girth was significantly greater in the cavernous-sparing group. A higher proportion of men in this group also had detectable cavernous arteries, thicker residual corporal tissue, better residual tumescence post-IPP and demonstrated significant increases in both PSV and EDV post-PDE5i, compared to no PDE5i. Men who had standard dilatation also responded to post-IPP PDE5i but fewer had identifiable cavernous artery and had significant increase in only PSV, compared to no PDE5i. Other articles relating to post-IPP pharmacotherapy unanimously demonstrated that post-IPP glans engorgement was improved. This equated to reported statistically improved satisfaction when compared to the IPP alone groups, as measured by IIEF and EDITS questionnaires. Post-IPP PDE5i were better tolerated than intraurethral alprostadil, which was associated with discomfort. Conclusions Post-IPP pharmacotherapy appears to enhance residual erectile tissue engorgement. It can be used as an adjunctive after-care measure. Cavernous-sparing techniques show the importance of viable residual tissue for improved prosthetic erections. More comprehensive studies are needed to enhance patient experience and explore the microanatomical and hemodynamic role of residual tissue post-IPP. Disclosure No.

(311) Reduced Glans Engorgement After Inflatable Penile Prosthesis – A Scoping Review of Factors Involved and Management Strategies

Abstract Introduction Inflatable penile prosthesis (IPP) provides a reliable stiffness along the length of the penile shaft, yet patients may express dissatisfaction as it may still differ from their recollection of their previously normal erections. A common complaint is reduced engorgement of the glans penis, which can manifest as subjective reduction in penile length or the feeling of a cold insensitive glans. Patient factors often ensure a sound justification for this complaint, namely vasculogenic erectile dysfunction (ED) or their corporo-glandular morphology despite a well-sized and well-positioned implant. Objective To identify factors that may contribute to reduced glans engorgement and possible management strategies. Methods Intervention: Any method of treating or avoiding reduced glans engorgement post-IPP. Population: Men undergoing IPP insertion or men with glans complaints post-operatively Inclusion Criteria: Articles published in English with full text available and objective outcome measures Search Strategy: Literature search was performed in June 2023 using Medline, PubMed, Embase and Scopus. PubMed search included both “Mesh” protocols and “free text” to capture the correct study population and intervention utilized. Review Type & Analysis: Although an initial systematic model was considered, a scoping model was ultimately selected due to the limited literature and inconsistent outcome measures. This approach aimed to identify gaps in knowledge and provide an overview of the existing literature, thus informing future studies in this area. The variability in outcome measures across studies prevented higher-powered analyses from being conducted. Results Initial search strategy retrieved 98 non-duplicate studies with 40 being selected for initial screening after applying inclusion criteria. Ultimately, a total of 7 articles were included and categorized by theme: Cavernous-sparing technique (1-3); Pharmacotherapy for post-IPP glans complaints (4-7) (Table 1 & 2). The cavernous-sparing technique described aims to limit disruption of cavernous tissue around the implanted cylinder. This was achieved by omitting dilatation and using Furlow directly for measurements, or by intraoperative intracavernosal (IC) prostaglandin followed by dilatation only with size 7 or 8 Hegar alone. In all studies that compared penile dimensions, girth was significantly greater in the cavernous-sparing group. A higher proportion of men in this group also had detectable cavernous arteries, thicker residual corporal tissue, better residual tumescence post-IPP and demonstrated significant increases in both PSV and EDV post-PDE5i, compared to no PDE5i. Men who had standard dilatation also responded to post-IPP PDE5i but fewer had identifiable cavernous artery and had significant increase in only PSV, compared to no PDE5i. Other articles relating to post-IPP pharmacotherapy unanimously demonstrated that post-IPP glans engorgement was improved. This equated to reported statistically improved satisfaction when compared to the IPP alone groups, as measured by IIEF and EDITS questionnaires. Post-IPP PDE5i were better tolerated than intraurethral alprostadil, which was associated with discomfort. Conclusions Post-IPP pharmacotherapy appears to enhance residual erectile tissue engorgement. It can be used as an adjunctive after-care measure. Cavernous-sparing techniques show the importance of viable residual tissue for improved prosthetic erections. More comprehensive studies are needed to enhance patient experience and explore the microanatomical and hemodynamic role of residual tissue post-IPP. Disclosure No.

Evaluation of vascular changes in cavernous arteries by penile doppler ultrasound in patients undergoing laparoscopic radical prostatectomy.

Patients undergoing radical prostatectomy for prostate cancer may experience erectile dysfunction (ED). Age of patients, experience of the surgeons and existence of ED before surgery are factors related to its appearance. The objective of the study was to assess the hemodynamic changes produced in the cavernous arteries in patients undergoing laparoscopic radical prostatectomy (LRP) measured with penile Doppler ultrasound (PDUS). A prospective database of 83 patients undergoing LRP was analysed. PDUS were performed at baseline and twelve months after surgery. International Index of Erectile Function (IIEF) and Erectile Hardness Score (EHS) questionnaires were also evaluated. A 12-month decrease in all hemodynamic parameters of both cavernous arteries was found except for the end diastolic velocity (EDV) on the left cavernous artery. Only changes between baseline and twelve-months mean values of the diameter (0.725 vs. 0.67 mm; p= 0.033) and peak systolic velocity (PSV) of the right cavernous artery (32.6 vs. 27.22 cm/s; p = 0.004) presented significant variations. The rest of the parameters were close to statistical significance, except for EDV of the right cavernous artery (p = 0.887). The erectile function domain of the IIEF showed a significant decrease (median at baseline: 26 vs. post-surgery: 7; p < 0.0001) as well as the EHS test (grade I at baseline: 2.4% vs. 12-months: 31.3%; p < 0.0001). Our study supports the idea that LRP produces local vascular injuries. A decrease in the PSV and in the diameter of both cavernous arteries was observed with PDUS and it may explain the vascular origin of ED.

Эмболизация артериокавернозной фистулы при артериальном приапизме: клинический случай

Arterial priapism occurs much less frequently than venous (non-ischemic, low-flow) priapism. Considering the absence of ischemia of the cavernous bodies in arterial priapism, emergency surgical intervention is usually not indicated, and a wait-and-see approach is acceptable. In the absence of spontaneous resolution of arterial priapism, invasive treatment may be performed upon the patient’s desire. Currently, the method of choice is super-selective embolization of branches of the internal pudendal, cavernous, or helical artery. This article presents a clinical case of arterial priapism, in which super-selective embolization of the cavernous artery with PVA (polyvinyl alcohol) embolization agent was performed, resulting in complete resolution of priapism after the operation.

Safety and potential effectiveness of platelet-rich plasma and extracorporeal shock wave therapy in the treatment of erectile dysfunction after nerve-sparing radical prostatectomy in patients: pilot study

Background. Prostate cancer is the most common type of cancer in men. Radical prostatectomy (RPE), including nerve-sparing, often leads to erectile dysfunction and a significant decrease in the quality of life. The available treatments are limited in effectiveness and/or are not suitable for patients.Aim. The aim of the study was to evaluate the safety and effectiveness of platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT) in the treatment of erectile dysfunction in patients after nerve-sparing RPE.Materials and methods. 14 men were included in the study after unilateral or bilateral nerve-sparing RPE more than 3 months ago. The total prostate-specific antigen in all patients was less than 0.2 ng/ml 3 months or more after surgery. Age – 57.8 ± 6.2 (49–72) years, duration of erectile dysfunction – 7.6 ± 3.9 (3–16) months. Two visits per week were out for 6 weeks: in visit 1, the ESWT (Dornier Aries) was performed on penis and injections of PRP into the penis, the muscles involved in the erection were activated at the end of the session by ESWT, in visit 2, ESWT on penis. The examinations were performed on the 0 and 60 days of the study: International Index of Erectile Function (IIEF-5), Sexual Encounter Profile (SEP), Erection Hardness Score (EHS), Global Assessment Questionnaire (GAQ), International Prostate Symptom Score (IPSS), Quality of Life (QoL), total blood testosterone, to penile duplex Doppler ultrasonography (PDDU) with prostaglandin E1 analog. Inclusion criteria were absence of metastases to distant organs and lymph nodes; stage no more than T3b; IIEF-5 less than 21 points after RPE; PSV less than 30 cm/s and/or RI less than 0.8 according to the PDDU after RPE; the presence of erections before RPE.Results. Treatment was tolerated satisfactorily for all patients. Significant improvement of erectile function was noted according to IIEF-5 (p &lt;0.05), SEP (p = 0.002), EHS (p = 0.002). According to GAQ, 11 patients (78.5 %) noted a positive effect of treatment. PSV and RI in both cavernous arteries increased significantly (p &lt;0.05) according PDDU. All patients noted a dysuria decrease based on IPSS (p = 0.007) and QoL (p = 0.58). The concentration of total testosterone in the blood without significant dynamics (p = 0.192).Conclusion. There are positive effects in relation to a significant improvement in erectile function in all patients according to validated questionnaires and PDDU. The proposed treatment is a promising method of restoring patient data. The study continues on a larger sample of patients.

Vacuum erection device for erectile function rehabilitation after radical prostatectomy: which is the correct schedule? Results from a systematic, scoping review.

Vacuum erection device (VED), for its capacity to improve the peak flow and elasticity of cavernous arteries, is a well-known tool to improve recovery of erectile function (EF) after radical prostatectomy. Aim of this study is to compare the different therapeutic schemes proposed in literature to find the most effective timing for VED treatment and to evaluate its efficacy alone or associated with phosphodiesterase 5 inhibitors (PDE5i). We performed a systematic review of Literature in October 2022 using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials to retrieve all articles dealing with EF rehabilitation after radical prostatectomy (excluding non-English papers, reviews, or meeting abstracts). Patients were divided among those receiving VED alone or combined with other treatments. Study outcomes were compared dividing them between those with follow-up shorter or longer than 12 months. Sixteen papers were included according to selection criteria. Among them, seven were randomized-controlled trials, five were prospective observational studies and four were retrospective. VED alone was evaluated in eight articles, while the remaining papers evaluated the combination of VED with PDE5i. Regarding VED therapeutic protocol, 7/16 studies used it daily. Rehabilitation protocol lasted less than 1 year in 4 studies, up to 12 months in 6 studies and more than 1 year in 6 studies. All the studies show improvement in International Index of Erectile Function Questionnaire (IIEF-5), conservation of penile length and satisfactory intercourses when compared to controls. VED results appear to increase when patients were addressed to VED-dedicated programs to enhance their compliance with the device.

PD12-06 MICRO-SURGICAL PENILE REVASCULARIZATION AFTER PELVIC FRACTURE URETHRAL INJURIES

You have accessJournal of UrologyCME1 Apr 2023PD12-06 MICRO-SURGICAL PENILE REVASCULARIZATION AFTER PELVIC FRACTURE URETHRAL INJURIES Reynaldo Gomez, Jessica Pfeifer, Laura Velarde, and Rodrigo Campos Reynaldo GomezReynaldo Gomez More articles by this author , Jessica PfeiferJessica Pfeifer More articles by this author , Laura VelardeLaura Velarde More articles by this author , and Rodrigo CamposRodrigo Campos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003259.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Micro-surgical revascularization of the penis after a pelvic fracture urethral injury (PFUI) has been proposed to recover erections and / or to improve the irrigation of the spongiosum prior to urethroplasty, aiming to prevent ischemic failure of the reconstruction. METHODS: Patients who lost their erection after a PFUI were studied with color Doppler ultrasound of the cavernous arteries after intracavernous injection of prostaglandin. Those diagnosed with arteriogenic erectile dysfunction were confirmed with a selective pudendal pharmaco-arteriography (with intracavernous prostaglandin) and were offered a micro-surgical penile revascularization by means of a bypass of the inferior epigastric artery to the dorsal artery of the penis. RESULTS: Between April 1990 and July 2022, 16 patients were revascularized before urethroplasty. All were acutely managed by suprapubic cystostomy without realigment. The median age was 32 years (range 20-57), the median time between the accident and revascularization was 9 months (range 2-30) and the median time between revascularization and urethroplasty was 2 months (range 1-7). The mean surgical time was 280 min (220-290), with no intraoperative complications. There were 2 Clavien I postoperative complications and one Clavien II.With a median follow-up of 102 months (range 3-367), no patient presented urethroplasty stricture failure and no patient recovered erections despite bypass patency (verified by postoperative Doppler ultrasound in 11). CONCLUSIONS: Micro-surgical revascularization of the penis is feasible and safe, requires expertise in micro surgery and does not seem to have a role in recovering erections after PFUI. On the other hand, long-segment ischemic stricture failure is an infrequent but catastrophic complication of urethral reconstruction linked to post traumatic penile arterial insufficiency. In this setting, penile revascularization may contribute to increase urethral blood flow and may be valuable to prevent ischemic failure of the urethral reconstruction. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e402 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Reynaldo Gomez More articles by this author Jessica Pfeifer More articles by this author Laura Velarde More articles by this author Rodrigo Campos More articles by this author Expand All Advertisement PDF downloadLoading ...

Age dynamics of the morphological structure of the cavernous arteries in healthy men according to complex morphometric analysis

Background. Erectile dysfunction is associated with systemic vascular diseases and, to a greater extent, with age, while there is insufficient data in the literature on the morphological state of the cavernous arteries (CA) in men of different ages in normal.Aim. A detailed morphometric assessment of the CA of men of various ages in the absence of signs of atherosclerosis and hypertension.Materials and methods. The material was transverse fragments of cavernous bodies with paired CA obtained during autopsy (58 observations, a total of 116 CA were examined). Hematoxylin and eosin, fuchsylin and picrofuxin, and Mallory staining were used. Detailed morphometric analysis was carried out according to the original method by measuring the perimeter and then calculating the area of the corresponding component of the vascular wall.Results. In the studied age range from 17 to 74 years, there was an increase in the total area of the CA from 0.76 mm2 in the age period of 17–21 years to 0.99 mm2 in the period of 36–60 years and a decrease to 0.43 mm2 at the age of 61–74 years. А similar increase in absolute indicators of the area of the lumen with a decrease in old age was revealed. The absolute area of intimacy and media, increasing by the age of 36–60 years, also significantly decreases in the age range of 61–74 years. At the same time, the relative area of intima to the vessel lumen has insignificant fluctuations, remaining a stable value in all age groups. The specific area of intima relative to the entire area of the vessel as a whole has a stable indicator, increasing in old age. The Kernogan Index tends to decrease throughout the studied age range from 33 to 26 %, which indicates the preservation of the spacecraft throughput in all the studied groups, including the elderly. This is also evidenced by the dynamics of the ratio of the diameter of the CA lumen to the thickness of the vessel wall, including intima and media, reaching maximum values of 4.15 by the period of 36–60 years, remaining at a high level of 3.53 and in the oldest age group. At the same time, the specific share of media significantly decreases in all groups of the studied age range of 17–74 years from 62.1 to 50.5 %. The ratio of the maximum lumen area of the vessel to the minimum as an indicator of the potential possibility of increasing the lumen of the spacecraft turned out to be maximum atthe ages of 17–21 years and 22–35 years,significantly decreasing in older age groupsfrom 176 to 130 %.Conclusion. Age-related remodeling of the spacecraft consistsin fairly stable morphometric parameters of the spacecraft in the age range from 17–21 years to a period of 36–60 years with a decrease at an older age, when a decrease in the absolute area of the lumen and the entire spacecraft isrevealed. A significant progressive decrease in the specific proportion of media and an increase in the proportion of intima in the structure of the vessel wall are shown. At the same time, up to the age of 36–60 years, spacecraft maintain their throughput indicators at a high level. Further studies of CA in vascular pathology may be useful in understanding the causes and mechanisms of the association of erectile dysfunction with the age of men.

Радиоволновая электротерапия с радиочастотой 448 кгц в лечении пациентов с органической эректильной дисфункцией: проспективное рандомизированное простое слепое Sham-контролируемое исследование в параллельных группах

To evaluate the efficiency of radio wave electrotherapy (448 kHz) for the treatment of patients with organic erectile dysfunction (ED).A prospective, randomized, blind, sham- controlled clinical trial was carried out. Inclusion criteria were as following: 1) patients with 5 to 20 points on the IIEF-5 score; 2) patients with proven organic erectile dysfunction lasting at least 6 months; 3) patients with penile arterial insufficiency and/or venous insufficiency, confirmed by doppler study of penile vessels with pharmacological stimulation (peak systolic velocity (PSV) <25 cm/s, end-diastolic blood flow velocity (DPV) >5 cm/s, resistance index (IR) < 0.8). The participants were randomized into two groups (experimental and control) in a 1:1 ratio. The full treatment course lasted 9 weeks. Patients underwent an assessment of erectile function based on questionnaires (IIEF-5, SEP, Schramek), as well as Doppler ultrasound of the cavernous arteries before inclusion in the study as well as a after treatment.The study included 61 men (experimental group [n=31], control group [n=30]. There was a significant difference in the IIEF-5 scores after treatment between the experimental group and the control group (19.5+/-3.2 vs. 15.1+/-5.4, p=0.017, respectively). Significant differences were also noted in mean total score of the SEP questionnaire: an increase to 3.6+/-1.0 in the treatment group compared to 2.4+/-1.1 in the control group (p=0.004). The results of the Schramek questionnaire also demonstrated a significant increase in the mean score in the experimental group compared to the control group: 4.2+/-0.6 vs. 3.2+/-1.0 (p=0.011). The response time to the drug and the detumescence time also significantly differed between the two groups: 11.9+/-4.0 min vs. 15.5+/-4.1 min, p=0.001 and 126.6+/-60.7 min vs. 66.2+/-40.9, p<0.001, respectively. Neither complications nor any adverse events were recorded during treatment or after its completion.Radio wave electrotherapy with a radiofrequency of 448 kHz can improve the IIEF-5, SEP and Schramek scores, as well as the indicators of ultrasound Doppler ultrasonography in patients with organic ED. To assess the feasibility of this method in patients with organic ED of different stages, further studies are needed.

Computed Tomography Scan Images of Sphenoidal Sinus Septa and Their Relations to the Internal Carotid Artery

The trigeminal nerve and optic nerve, cavernous sinus optic chiasm, pituitary gland, and internal carotid artery are all encircled by the sphenoid sinus, which is located in the sphenoid. More than one asymmetrical vertical septa separate the sphenoidal sinus. Because of its position and linkages with important neurovascular and glandular systems, the sphenoid sinus poses a substantial diagnostic and therapeutic challenge. Objective: To look at the relationship between sphenoid sinus septation and the number and position of the internal carotid artery in people from Peshawar, Pakistan. Methods: The prospective study was conducted from November 2019 to April 2020 at the Radiology Department of a Khyber Teaching Hospital, Peshawar, the CT image was performed on 150 patients (100 males, 50 females) of the paranasal sinuses. From the originating axial slices, secondary coronal scans were obtained. Only individuals with no sphenoid sinus problems were included in the research to examine anatomical changes in the septation of the sphenoid sinus. Results: According to CT scans of the participants, 34% of males and 23% of females had more than one sphenoid septum, with 24 men accounting for 20.8 % and 16 female cases (16.8%) having the septum attached to the posterolateral wall of the sinus of the carotid canal. Conclusions: Prior to surgery, a CT scan of the paranasal sinuses is essential to rule out any potential complications caused by anatomical differences.

Dorsal Artery Branches to the Corpora Cavernosa

ABSTRACT Introduction Understanding the penile arterial anatomy and its preservation is of interest to reconstructive and oncologic surgeons. The predominant cavernosal arterial supply is provided by the cavernous artery (CA) as it branches from the internal pudendal artery (IPA). Penile ultrasound and cavernosography have demonstrated the existence of accessory arteries originating from the dorsal artery of the penis (DA). Assessment of the arterial anatomy has largely been limited to imprecise ultrasound or invasive angiography. Objective To describe the anatomic findings relating to DA branching patterns in the penis among men undergoing CT cavernosography for evaluation of sexual dysfunction. Methods Images from CT cavernosography were reviewed in a sequential cohort of men. Imaging was reviewed to delineate the arterial anatomy with respect to the CA and DA branches distal to the pubic symphysis as noted by an absence of contrast in a linear hiatus within the corpora cavernosa. Data included the presence of an identifiable CA or DA branch, their diameters, the number of DA branches, distance from the pubic symphysis, and the approximate branching angle. Results 68 men had imaging available for analysis, 57 of whom underwent evaluation for ED and 37 for penile curvature. At least one CA was identifiable in 88% of men with a mean diameter of 1.66mm (Median 1.40, [IQR 1.30, 1.90]). DA perforating branches were identified in 90.8% of men, with a mean of 2.1 discrete branches per patient (Median 2, [IQR 1,3]). 26 men had penile doppler data available for comparison. Among those men, the mean CA diameter after injection was 1.51mm and the ratio between diameter measured on doppler and CT was 1.0. 4 patients had a DA branch identified on penile doppler and all had at least one DA branch identified on CT. 19 patients had at least one DA branch identified on CT which was not seen on penile doppler. In a subset of 33 patients with further CT data available for review, the mean number of DA branches identified was 2.24 (Median 2, [IQR 1,3]), with a mean DA branch diameter of 1.39mm (Median 1.40, [IQR 1, 1.70]). The first branch was identified at a mean of 2.06cm distal to the pubic symphysis with a branching angle of approximately 49.75 degrees, and the second branch was identified at a mean of 3.4cm distal to the pubic symphysis with a branching angle of approximately 50.62 degrees. Conclusions Dorsal artery contribution to the cavernosal blood supply may be more variable than previously thought. This is of interest to those performing penile doppler for assessment of blood flow given that it may be difficult to delineate the CA and DA in some patients. The impact of these DA branches on sexual function is not clear and warrants further investigation. Disclosure No

Homocysteine levels correlate with velocimetric parameters in patients with erectile dysfunction undergoing penile duplex ultrasound.

IntroductionHyperhomocysteinemia may contribute to the development of endothelial dysfunction and, consequently, atherosclerosis, a systemic disease involving the vessels that may affect the cavernous arteries leading to vasculogenic erectile dysfunction. Our study aims therefore to explore the relationship between homocysteine levels and velocimetric parameters detected by basal penile duplex ultrasound such as peak systolic velocity and flaccid penile acceleration in patients with erectile dysfunction.MethodsA cross‐sectional study was conducted collecting clinical, metabolic, hormonal, and instrumental (basal penile duplex ultrasound) data in patients affected by vasculogenic erectile dysfunction.ResultsData of 126 subjects affected by erectile dysfunction were collected. Mean age was 52.1 ± 12.6 years, whereas mean body mass index was 25.6 ± 4.0 kg/m2. Basal penile duplex ultrasound showed peak systolic velocity values of 13.1 ± 2.9 cm/s and mean flaccid penile acceleration of 2.28 ± 0.70 m/s2, with a strong correlation among these two parameters (r = 0.690; p < 0.001). Frankly pathological values of peak systolic velocity and flaccid penile acceleration were detected in 39.7% and 4.8% of the subjects examined, respectively. Mean homocysteine levels were 14.9 ± 9.5 μmol/l. Homocysteine values >15 μmol/l were found in 26% of the subjects with erectile dysfunction. Peak systolic velocity values and homocysteine levels showed an inverse correlation (r = –0.213; p = 0.03). Similarly, flaccid penile acceleration values were inversely correlated to homocysteine levels (r = –0.199; p = 0.05). In addition, an inverse correlation was found between both peak systolic velocity and flaccid penile acceleration and body mass index, atherogenic lipid pattern, and age. Homocysteine and metabolic parameters showed no significant correlations.ConclusionHyperhomocysteinemia is highly prevalent in erectile dysfunction patients. The results of our study show that homocysteine levels correlate with velocimetric parameters assessed by basal penile duplex ultrasound, confirming the role of hyperhomocysteinemia in the genesis of erectile dysfunction of arterial origin.

Transvenous coil embolization for cavernous sinus internal carotid artery ruptured aneurysm after flow diverter placement

Transvenous coil embolization for cavernous sinus internal carotid artery ruptured aneurysm after flow diverter placement

Long-term high-dose l-arginine supplementation in patients with vasculogenic erectile dysfunction: a multicentre, double-blind, randomized, placebo-controlled clinical trial

PurposeThe current randomized, double-blind, placebo-controlled clinical trial addressed the effects on penile erectile function of relatively high daily oral doses (6 g/day) of l-ARG for 3 months (N = 51) compared to placebo (N = 47), in patients with vasculogenic ED, with comparison between mild–moderate and severe vasculogenic ED.MethodsThe outcome measures included IIEF-6 score and cavernous arteries peak systolic flow velocity (PSV) at dynamic penile duplex ultrasonography (PDU).Resultsl-ARG supplementation for 3 months significantly increased IIEF-6 score in the overall cohort (p < 0.0001) and in subgroups of patients with mild–moderate (p < 0.0001) and severe (p = 0.007) vasculogenic ED; PSV was significantly increased in the overall cohort (p < 0.0001) and in patients with mild–moderate (p < 0.0001), but not severe vasculogenic ED. At study completion, 74% of patients improved ED degree category, although only 24% of patients, mainly belonging to the baseline category of mild ED, reached IIEF-6 scores compatible with absence of ED; moreover, 20% of patients, exclusively belonging to the baseline category of mild–moderate vasculogenic ED, reached PSV values compatible with absence of ED.ConclusionThe results of the current study demonstrated that supplementation with relatively high doses of l-ARG as a single compound for 3 months significantly improved penile erectile function, assessed by both IIEF-6 score and PSV at dynamic PDU in patients with mild–moderate, and improved IIEF-6 score, but not PSV, in patients with severe vasculogenic ED, therefore suggesting that l-ARG might be an alternative treatment in mild–moderate vasculogenic ED patients experiencing adverse effects or with contraindications for chronic treatment with PDE5i compounds.

Fundamentals of the Treatment of Male Erectile Dysfunctions with Low Intensity Shock Waves

Male erectile dysfunction (ED) is one of the most common problems among men worldwide. No single diagnostic method evaluates all the variables of this complex condition. To achieve good therapeutic results, it is essential to base the treatment on an accurate diagnosis. Hemodynamic exploration by echo Doppler of the cavernous arteries, especially since the incorporation of intracavernous administration of vasoactive drugs, is a useful tool that allows the evaluation of erectile dysfunction in the arterial phase. It is also considered to be the choice in the assessment of the corporoveno-occlusive mechanism. Different treatment methods are used, being PDE5 (sildenafil and tadalafil), the treatment of the first choice in several conditions. The number of publications of low-intensity extracorporeal shockwave treatment (LIESWT) for ED has increased dramatically in recent years. Scientific evidence regarding the application of LI-ESWT for the treatment of erectile dysfunction is still controversial. Inclusion criteria of the studies and the wide variety of treatment protocols have been criticized. On the other hand, most of these studies report encouraging results with no short-term adverse effects, regardless of variation in LI-ESWT setup parameters or treatment protocols.

Results of ultrasound dopplerography of the penis in patients with before and after transurethral enucleation of benign prostatic hyperplasia

BACKGROUND: The development of modern technologies for the surgical treatment of urological diseases poses new questions for urologists. One of them is to evaluate the effect of transurethral enucleation of benign prostatic hyperplasia on the erectile function of patients.&#x0D; AIM: The aim of the study was to assess the state of erectile function in patients before and after transurethral enucleation of benign prostatic hyperplasia using Doppler ultrasound of the vessels of the penis.&#x0D; MATERIALS AND METHODS: The study included 102 patients with benign prostatic hyperplasia aged 50 to 80 years (average 65 years) with complaints of erectile dysfunction and urinary disorders. All patients underwent transurethral enucleation of benign prostatic hyperplasia: 55 patients with the laser method (HoLEP, group 1) and 47 patients with the bipolar method (TUEB, group 2). The severity of ED was assessed using the IIEF-5 questionnaire (International Index of Erectile Function). To assess the state of blood flow in the penis, ultrasound dopplerography of the vessels of the penis was performed using a vasoactive erection stimulator. The studies were carried out before surgery and 24 weeks after it.&#x0D; RESULTS: The results of ultrasound dopplerography of the vessels of the penis before surgery revealed the arteriogenic type of ED in 18 (17.6%) patients, the venous type in 45 (44.2%) patients, the mixed arteriovenogenic type in 22 (21.6%) patients. In 17 (16.7%) patients ED was regarded as psychogenic. 24 weeks after the operation in patients of both the 1st and 2nd groups, according to the data of the IIEF-5 questionnaire, positive dynamics of the severity of erectile function was noted, regardless of the type of ED. For patients with vasculogenic types of ED, similar trends were noted regardless of the type of surgery. Thus, in patients with arteriogenic and arteriovenogenic ED a significant increase in the maximum systolic blood flow velocity (Vmax) in the cavernous arteries was recorded, while the values of the resistance index (RI) did not change significantly. At the same time, the Vmax values in these patients were initially low before the operation, and after the operation did not reach the reference values. In patients with venogenic ED, there was no significant improvement in penile blood flow, as evidenced by the absence of significant differences in Vmax and RI values. At the same time, the RI in these patients before the operation was reduced, and the Vmax values were in the range of normal values.&#x0D; CONCLUSIONS: The erectile function of patients after transurethral enucleation of benign prostatic hyperplasia improves regardless of the type of operation and the type of erectile dysfunction. Ultrasound dopplerography of the vessels of the penis is a minimally invasive and highly informative diagnostic method that makes it possible to detect circulatory disorders in the penis and assess its state in dynamics during treatment.

Application of the complex Edelim in pathogenetic management of patients with erectile dysfunction

AIM: To assess the degree of changes in complaints, dynamics of biochemical parameters of lipid metabolism, penile hemodynamics in patients with ED during therapy with EDELIM in comparison with PDE-5 inhibitors. Assess the tolerability of the drug based on the analysis of reported adverse events.&#x0D; MATERIALS AND METHODS: The study was prospective comparative observational cohort. The study included 60 patients over 18 years old with complaints of persistent, at least 1 month, erectile dysfunction. The patients were divided into 2 groups: group 1 patients with ED received Edelim on a regular basis, one capsule 2 times daily for 3 months; group 2 patients with ED received generic tadalafil 5 mg daily for 1 month, then 1 month break, then 5 mg per day for 1 month.&#x0D; RESULTS: The mean age of the patients was 38.4 9.2 years. In group 1, significant differences were noted in the all hemodynamic and biochemical indicators, except for HDL levels (2.2 0.4 vs. 2.3 0.4 mmol/L; p = 0.067). In group 2, significant differences were noted in the dynamics of the IIEF-5 scale, the level of HDL, and the blood flow velocity in the right and left cavernous arteries. There were no significant differences in blood flow in the left and right dorsal arteries, levels of total cholesterol, LDL, triglycerides, glucose, HbA1c, systolic blood pressure. In the 1st group of patients, there were no adverse events, in the 2nd group, in 3 patients mild side effects.&#x0D; CONCLUSIONS: The improvement in the quality of erection in the group of patients taking Edelim is associated with decrease in the lipid profile, glucose, glycated hemoglobin, which can be regarded as a variant of pathogenetic conservative treatment of ED.

Эректильная дисфункция: взаимосвязь показателей гемодинамики полового члена и диастолической функции левого желудочка

Introduction. Erectile dysfunction (ED) is one of the most common male urological complaints. At the same time, ED is pathogenetically closely associated with many life-threatening diseases (coronary heart disease, cerebrovascular diseases). Purpose. Based on Doppler data, determine the relationship between the blood flow in the cavernous arteries and intracardiac hemodynamics. Materials and methods. There are 246 men aged 40-65 years with complaints of erectile dysfunction was evaluated. The examination included anthropometry, questionnaires (IIEF-5, AMS), biochemical, hormonal blood tests and a comprehensive instrumental study: (Penile Doppler ultrasound, Holter ECG monitoring, Treadmill test, EchoCG). Results. Patients with arteriogenic ED have a significantly different risk factor profile. These patients have worse indicators of intracardiac hemodynamics compared to ED of other etiology - a higher ratio of the maximum rate of early and late left ventricular filling (E / A), lower rates of slowing down of early diastolic left ventricular filling and the time of isovolumic relaxation of the left ventricle. A significant correlation was found between the peak systolic blood flow velocity in the cavernous bodies of the penis, the resistance index in the cavernous arteries, and the E/A ratio. Discussion. Arteriogenic ED may be a sign of left ventricular diastolic myocardial dysfunction in men without symptoms of cardiovascular disease and may be a criterion for the formation of a group of high cardiovascular risk. Conclusions. Penile hemodynamics can be used as a predictive marker for early forms of cardiovascular disease.