Corpus Cavernosum Electromyography Research Articles

A possible mechanism of erectile dysfunction in coronavirus disease-19: Cavernosal smooth muscle damage: A pilot study

IntroductionStudies have reported that coronavirus disease 2019 (COVID-19) may cause erectile dysfunction (ED), however, its role in the pathophysiology of ED has not yet been fully elucidated. We aimed to elucidate COVID-19's effects on cavernosal smooth muscle, which has a pretty important role in erection physiology, by corpus cavernosum electromyography (cc-EMG). Materials and methodsTwenty-nine male patients aged 20–50 years who applied to the urology outpatient clinic due to ED were included in the study. Nine patients that had COVID-19 and were treated as outpatients were classified as group 1, 10 patients who were hospitalized due to COVID-19 were classified as group 2, and 10 patients who did not have COVID-19 were classified as the control group (group 3). Patients underwent diagnostic evaluation including International Index of Erectile Function (IIEF)-5 form, penile color Doppler ultrasonography (CDUS), cc-EMG, and fasting serum levels of reproductive hormones (07–11am). ResultsAccording to penile CDUS and hormonal values results, there was no significant difference between the groups. According to cc-EMG results, amplitudes and relaxation capacities of the cavernosal smooth muscle of patients in group 3 were significantly higher than those in the other groups. ConclusionsCOVID-19 can cause ED not only by psychogenic and hormonal factors but also with cavernosal smooth muscle damage.Clinical Trial Registration Number: NCT04980508.

The role of computerized tomography angiography in the management of cases undergoing penile revascularization due to erectile dysfunction: prospective cohort study

In this study, the role and efficiency of computerized tomography angiography (CTA) in the postoperative management of patients with penile revascularization were evaluated. Between 2014 and 2018, penile revascularization surgery was performed in 78 patients who presented with the complaint of erectile dysfunction (ED). The mean age of the patients was 47.17 ± 13.26 (23-69) years. Patients with a regular sexual partner and relationship, who hadn't benefitted from medical treatment and who had ED complaints for at least three months were included in the study. The cases were divided into three groups according to their age (20-40, 41-60, and > 61years). All the cases were evaluated preoperatively using the five and 15-item International Index of Erectile Dsysfunction (IIEF-5 and IIEF-15) questionnaire, cavernosometry, corpus cavernosum electromyography, and penil color doppler ultrasonography. At the postoperative third month, IIEF 5-15 questionnaire was repeated and anastomotic patency was evaluated by performing CTA scanning. CTA performed at the postoperative third month revealed anastomosis patency in 56. In 22 cases, the anastomosis area could not be observed. Among the patients with anastomosis patency, the rate of the IIEF-5 increase in the postoperative period was between 35.0 and 80.8%, while in those patients without anostomotic patency, the increase rate of IIEF-5 were between 12.5 and 23.3%. Increases in the IIEF-5 and IIEF-15 questionnaire scores were found to be significantly higher in the group in which anastomotic patency was observed on CTA compared to remaining patients. The CTA results and changes in the IIEF rates after penile revascularization had a high correlation. Anastomotic patency with CTA can guide the timing of more invasive procedures such as penile prosthesis implantation.

A new diagnostic definition for patients with lower urinary tract symptoms evaluated by corpus cavernosum electromyography: 'Pelvic autonomic dysfunction'.

This study investigates the use of corpus cavernosum electromyography (CC-EMG) recording as a diagnostic tool for identifying the presence of pelvic autonomic dysfunction (PAD) in patients with LUTS and concurrent ED. Fifty patients were included in the study, and the electromyographic and urodynamic findings were compared. The 50% relaxation degree was accepted as a threshold value for PAD. According to relaxation degree in CC-EMG recordings, patients were grouped as; Group 1 (with PAD)=23 patients with a relaxation degree of less than 50%. Group 2 (without PAD)=27 patients with a relaxation degree greater than 50%. The mean age of the patients was 58 ± 3.2 (50-71) years. The comparison of the urodynamic parameters and transrectal ultrasound revealed that the postvoiding residual urine volume (PVR) (p=0.0007), P det Qmax (p=0.0005), and P det compliance (0.003) values were statistically significantly lower in Group 2. The mean IIEF-5 and IIEF-15 scores of the patients in Group 1 were 2.5 ± 0.7 and 8.1 ± 1.1 respectively. In Group 2, mean IIEF-5 and IIEF-15 scores were 7.2 ± 2.9, and 17.2 ± 3.5 (p: 0.00023 and p: 0.0009). The mean I-PSS score was 22.8 ± 3 in Group 1 and 16 ± 2.3 in Group 2 (p=0.001). The mean relaxation degree (RD) in Group I was 30.73 ± 6.8%, and in Group 2 was 66.3 ± 5.1%. The mean amplitude values of the patients in Group I were 261.41 ± 112.97 before papaverine injection, and in Group 2 were 246 ± 101.28 respectively. The inter-group difference was statistically significant (p < 0.05). The mean amplitude value of the patients in Group I after papaverine injection was 182.73 ± 60.71, and in Group 2, that value was 83.2 ± 29.19. The inter-group difference was also significant (p < 0.05). Increased electrical bursts and decreased relaxation responses on CC-EMG indirectly indicated an increase in the contractility of the bladder sphincter. Therefore, we concluded that CC-EMG could be a diagnostic tool for PAD and cavernous autonomic dysfunction.

Cavernous smooth muscles: innovative potential therapies are promising for an unrevealed clinical diagnosis.

While erectile dysfunction (ED) is highly prevalent worldwide, unrevealed cavernous smooth muscles (CSM) defects can confound the diagnosis of vascular ED and lead to failure of treatments. Currently, the first-line oral treatment for ED is phosphodiesterase type 5 inhibitors (PDE5Is). Patients with diabetes mellitus (DM), those who have undergone a radical prostatectomy (RP), and the elderly population are difficult to treat by the PDE5Is; unrevealed CSM defects can result in corporo veno-occlusive dysfunction (CVOD); and penile veno-ligation surgeries are currently abandoned due to high failure rates. It has been found that gene and stem cell therapies, among others, reduce cavernous tissue apoptosis and fibrosis and can specifically target CSM defects such as the nitric oxide (NO)-mediated signaling pathway, Rho-ROCK system, and transformation growth factor (TGF)-β1/angiotensin II (Ang II) pathway, in several laboratory animals. Current data clarify the need of diagnostic techniques that can provide an initial assessment of CSM. This assessment should be essential before giving a diagnosis of vascular ED and before applying several tests searching for a specific CSM defect to guide the specific therapy. Moreover, while patients with corporal fibrosis would fail the current medical therapies, these patients can benefit from the stem cell-based therapies that induce the internal mechanisms of tissue repair. However, penile elastography can determine the stiffness of tissues and corpus cavernosum electromyography (CC-EMG) can assess the integrated activity of CSM bulk, further refinements are required for these techniques before being considered in the evaluation of patients with ED. In conclusion, on the basis of the current scientific research, it may be possible to formulate new therapies and achieve the appropriate selection of patients who can benefit from these therapies.

Establishment of Novel Intraoperative Monitoring and Mapping Method for the Cavernous Nerve During Robot-assisted Radical Prostatectomy: Results of the Phase I/II, First-in-human, Feasibility Study

BackgroundPotency preservation often does not meet expectation despite nerve-sparing prostatectomy. ObjectiveTo set the protocol for intraoperative cavernous nerve monitoring and mapping during robot-assisted radical prostatectomy (RARP), and to evaluate its safety and clinical feasibility. Design, setting, and participantsA prospective phase I/II, feasibility study was performed. A total of 30 patients with prostate cancer who underwent RARP at a high-volume tertiary academic hospital were enrolled. Surgical procedurePudendal somatosensory evoked potential, bulbocavernosus reflex, spontaneous corpus cavernosum electromyography (CC-EMG), median nerve stimulation evoked CC-EMG, and neurovascular bundle (NVB)-triggered CC-EMG with various stimulation protocols were assessed during conventional RARP under total intravenous anesthesia with controlled muscle relaxation. MeasurementsThe primary endpoint was the completion rate of planned surgery and assessment. Adverse events, and erectile and urinary functions were evaluated within 1 yr. CC-EMGs were graded and correlated with functional outcomes. Results and limitationsThe completion rate was 100%. Only one patient experienced adverse events, which were not related to study intervention. Grades of CC-EMGs including NVB-triggered CC-EMG before prostate removal were associated with baseline five-item International Index of Erectile Function (IIEF-5) score (grades 0–1, 4.6±2.7; grade 2, 13.2±6.8; grades 3–4, 16.6±5.9; p=0.003). Furthermore, grades of CC-EMGs including NVB-triggered CC-EMG after prostate removal were significantly associated with potency recovery (grade 0, 12.5%; grade 1, 0%; grade 2, 33.3%; grades 3–4, 100% at 12 mo; p=0.005) and postoperative IIEF-5 scores at all evaluation time points (grades 0–1, 2.6±2.8; grade 2, 4.3±5.8; grades 3–4, 15.7±11.0 at 12 mo; p=0.003). ConclusionsWe successfully established the protocol for safe intraoperative cavernous nerve monitoring and mapping using CC-EMG during RARP. Its grades were well correlated with erectile function. Patient summaryIn this first-in-human feasibility study, we successfully established the protocol for safe intraoperative cavernous nerve monitoring and mapping method during robot-assisted radical prostatectomy. The results were significantly associated with erectile function. Evaluation of clinical efficacy to preserve potency seems worthy of further optimization and investigation in confirmatory clinical trials.

The application of spontaneous corpus cavernosum EMG to assess the status of cavernous smooth muscles, a preliminary study

IntroductionDiagnostic tests for vascular erectile dysfunction (ED) depend on cavernous smooth muscles (CSM) relaxation following an intracorporal injection (ICI). Enhanced sympathetic tone, which is not uncommon during performance of these tests, can bias its results. Also, CSM diseases can cause veno-occlusive diseases (VOD) ED. Corpus cavernosum electromyography (CC-EMG) potentials’ amplitudes represent the integrated sympathetic activity of healthy CSM. Stem-cells and gene-therapy are potential therapeutic options for impaired CSM. ObjectiveTo utilize CC-EMG, as a new diagnostic technique that can confirm the integrity of CSM, and to identify patients with impaired CSM activity, among those diagnosed as vascular ED per Color Duplex Doppler Ultrasonography (CDDU). Patient and methodsGroup 1 included 24 patients with ED and negative response to ICI. Group 2 included 10 men without ED. Patients included in group 1 had penile CDDU examination and all participants had spontaneous CC-EMG recordings. ResultsAccording to CDDU parameters, group 1 was sub-grouped as nine arterial, ten VOD and five mixed type. CC-EMG potentials’ amplitudes ranged 223–320, 179–237, 103–250 and 83–200μV for group 2 and arterial, mixed and VOD subgroups respectively. The widest ranges of potentials’ amplitudes were recorded in the subgroups of patients with an element of VOD. Four patients with ED, within these subgroups, had CC-EMG potentials’ amplitudes ranged 200–250μV that exceeded/approached the lowest value recorded from men in group 2. ConclusionCC-EMG recordings elicited marked differences of CSM activity among patients diagnosed with an element of VOD ED per CDDU. This finding highlighted the need to utilize CC-EMG to assess the integrity of CSM. Identifying patients with impaired CSM activity may modify the chosen methods for therapeutic interventions.

MP25-16 PENILE REVASCULARIZATION SURGERY IN PATIENTS WITH DIABETIC ERECTILE DYSFUNCTION : LONG TERM RESUTS

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy I1 Apr 2017MP25-16 PENILE REVASCULARIZATION SURGERY IN PATIENTS WITH DIABETIC ERECTILE DYSFUNCTION : LONG TERM RESUTS Onder Kayigil, Emrah Okulu, and Fatih Akdemir Onder KayigilOnder Kayigil More articles by this author , Emrah OkuluEmrah Okulu More articles by this author , and Fatih AkdemirFatih Akdemir More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.766AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To determine the overall long-term success of penile revascularization surgery in the treatment of vasculogenic erectile dysfunction and also to investigate the effect of risk factors on the results of a modified Furlow-Fisher technique.We completed our revascularization surgery results in our 50 erectile dysfunction patients having no risk factors except diabetes with a long term follow-up. METHODS Between 2004 and 2015,225 patients with a mean age of 47.2(range:23–73) years underwent penile revascularization surgery.Among them, 50 patients were diagnosed as having diabetes mellitus and completed the mean 60,94±1,34 months follow-up.All the patients were routinely interviewed in the Departments of internal Medicine,Neurology,Psychiatry,and Anaesthesiology.Preoperative urological evaluation was performed with penile colour Doppler ultrasonography,corpus cavernosum electromyography(CC-EMG) and cavernosometry.At least five points of increase in the IIEF-5 score during the latest patient visit in the postoperative period compared with the preoperative period was regarded as improvement(surgical success). RESULTS The mean total IIEF score was 28.1±5.7 before surgery,and it was 42.2±6.3 at the end of the follow-up(P<0.05).The mean IIEF-5 score was 8.3±2.2 before surgery,and it was 17.7±2.1 at the end of the follow-up(P<0.05).Before surgery, the mean Erectile Function-domain score was 11.6±3.4,and it was 21.7±6.1 at the end of the follow-up(P<0.05).According to the IIEF-15,32 patients achieved a no-ED threshold value of >26.According to the IIEF-5, the surgery was again successful in 35 of 50 diabetic patients(70%). CONCLUSIONS We suggest that penile revascularization surgery could be an alternative choice before penile prosthesis implantation in those patients having no risk factors except diabetes which is under control. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e316-e317 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Onder Kayigil More articles by this author Emrah Okulu More articles by this author Fatih Akdemir More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Standard Operating Procedures for Neurophysiologic Assessment of Male Sexual Dysfunction

Can neurophysiological testing in male patients with sexual dysfunction benefit the decision-making process? The answer remains unclear. To provide standard operating procedures for the neurophysiologic assessment of male sexual dysfunction. Medical literature was reviewed and combined with expert opinion of the authors. Bulbocavernosus reflex latency time, pudendal somatosensory evoked potentials, and sympathetic skin responses have been considered as potential candidates for the diagnosis and assessment of erectile dysfunction (ED). Currently, there is no consensus on a standardized methodology for these neurophysiological investigations in the overall assessment of ED. These procedures are unable to assess the integrity of the efferent parasympathetic proerectile penile innervation; accordingly, none of these assessment procedures is recommended for ED patients. Corpus cavernosum electromyography (CC-EMG) can detect abnormalities in cavernous smooth muscle although these alterations can be attributed both to damage to autonomic penile innervation and to degenerative processes of the cavernous smooth muscle. CC-EMG is still considered experimental. Evidence does not support that men with premature ejaculation (PE) are consistently characterized by penile hypersensitivity; accordingly, penile threshold determination is not recommended to in the diagnosis of PE. Neurophysiological investigation of other components of the penile sensory pathways in PE patients has not provided any definitive contribution to the diagnosis. No neurophysiological assessment procedures yield additional information that consistently aids in the assessment of PE and ED.

Corpus Cavernosum Electromyography Revisited: Defining the Origin of the Signal

We performed this study to identify the source of complexes recorded during corpus cavernosum electromyography. A total of 10 healthy male volunteers 19 to 54 years old (mean age 36) with normal erectile function, participated in the study. A Porti electrodiagnostic system (TMS International, Enschede, The Netherlands) connected to a notebook computer recorded low frequency corpus cavernosum electromyography complexes via penile surface electrodes in 3 phases. In phase 1 baseline corpus cavernosum electromyography was recorded for 30 minutes. In phase 2 penile skin block was performed followed by 30 minutes of corpus cavernosum electromyography recording. Phase 3 consisted of intracavernous block followed by corpus cavernosum electromyography recording for 30 minutes. During all 3 phases startling auditory stimuli and median nerve stimulation were used at random intervals to evoke a sympathetic nervous system response. A suprapubic electrode was used as a control to record sympathetic electrodermal activity. In phase 1 all subjects had spontaneous and evoked corpus cavernosum complexes. The penile skin block used in phase 2 did not affect the presence of these complexes, which remained present in all subjects. During phase 3 no spontaneous or evoked corpus cavernosum complexes were recorded in any subjects, indicating that the intracavernous block eliminated the corporally generated signal. All subjects in all 3 phases demonstrated a sympathetic electrodermal response in the suprapubic electrode in response to evoking stimuli. This study confirms the penile cavernous tissue, and not the penile skin or surrounding tissue, as the origin of the corpus cavernosum electromyography complex. Further refinement of this technique may render it useful in the evaluation of neurogenic and myogenic erectile dysfunction.

Penile revascularization in vasculogenic erectile dysfunction (ED): long‐term follow‐up

To determine the overall long-term success of penile revascularization surgery in the treatment of vasculogenic erectile dysfunction (ED) and also to investigate the effect of risk factors on the results of a modified Furlow-Fisher technique. Between 1999 and 2010, 125 men with a mean (sd, range) age of 43.2 (11.3, 23-69) years underwent penile revascularization surgery. In all, 110 men completed the long-term follow-up with a mean follow-up of 73.2 months. Diagnostic evaluations, penile colour Doppler ultrasonography, corpus cavernosum electromyography, and cavernosometry, were performed in all the men before surgery. The efficacy of the surgery was assessed as improvement or failure according to the change in the five-item version of the International Index of Erectile Function (IIEF-5). A ≥5 point increase in the IIEF-5 score during the latest patient visit after surgery compared with that before surgery was regarded as improvement (surgical success). The mean (SD) IIEF-5 score was 7.3 (3.2) before surgery and at the end of the follow-up period it was 16.8 (3.1). The success rates were 81.8% at 3 months, 77.2% at 1 year, 70% at 2 years, 66.3% at 3 years and 63.6% at 5 years after surgery in the men who achieved a no-ED threshold score of >26 in the IIEF-15. The success rate was the highest in the men with no risk factors (92.8%). Seven patients (6.36%) showed signs of glans hypervascularization as a major complication. Penile revascularization surgery has not been widely used by urologists probably due to the technical difficulties and the use of phosphodiesterase type 5 inhibitors. However, with reported high rates of noncompliance or failure of oral pharmacotherapy it seems likely that this surgery will become more popular in the near future.

2017 PENILE AUTONOMIC INNERVATION: CORPUS CAVERNOSUM ELECTROMYOGRAPHY REVISITED

You have accessJournal of UrologyInfertility: Physiology, Pathophysiology, Basic Research1 Apr 20112017 PENILE AUTONOMIC INNERVATION: CORPUS CAVERNOSUM ELECTROMYOGRAPHY REVISITED Laura Leddy, Xiaogang Jiang, and Claire Yang Laura LeddyLaura Leddy Seattle, WA More articles by this author , Xiaogang JiangXiaogang Jiang Seattle, WA More articles by this author , and Claire YangClaire Yang Seattle, WA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2245AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Electrophysiological measurement of penile autonomic nervous system electrical activity has proven difficult. Corpus cavernosum (CC) electromyography (EMG) was first described in 1989, as a method to measure penile autonomic (sympathetic) innervation. However, interest in the technique waned, in part due to concerns about the origin of the recorded signal. We revisited this technique as a possible tool for the evaluation of neurogenic impotence, which is often a diagnosis of exclusion. Our hypothesis was that the recorded spontaneous and evoked CC potentials derived from the tissue of the corpus cavernosum and not the penile skin. METHODS We recruited healthy male volunteers with normal erectile function confirmed by the International Index of Erectile Function (IIEF). A Porti electrodiagnostic system (TMS International, The Netherlands) connected to a portable computer recorded low-frequency CC-EMG signals via penile surface electrodes during 3 phases: (1) Baseline CC-EMG was recorded for 30 minutes. (2) A penile ring block was performed by injecting subdermally 20cc of 1% lidocaine, followed by 30 minutes of CC-EMG recording. (3) An intracavernosal block using 2cc of 1% lidocaine was injected into the left corporal body, followed by CC-EMG recording for 30 minutes. Alternating startling stimuli, via auditory and median nerve stimulation, were used to evoke penile autonomic signals at random time points during the 3 phases. A suprapubic electrode was used as a control to record sympathetic electrodermal activity. RESULTS Eight healthy male volunteers, ages 19–54 (mean 36) participated. All subjects demonstrated spontaneous and evoked CC-EMG complexes during Phase 1. Evoked CC complexes were preceded by a sharp spike in the penile and suprapubic electrodes. In Phase 2 all subjects had spontaneous and evoked CC complexes. The sharp spike was maintained in the suprapubic electrode but not in the penile electrodes, indicating the skin block eliminated the penile electrodermal response. In Phase 3 no spontaneous or evoked CC complexes or penile electrodermal activity were apparent in any subject, indicating the intracavernosal block eliminated the corporal-generated signal. The suprapubic electrode continued to demonstrate a sharp spike in response to evoking stimuli in all study subjects. CONCLUSIONS This study uses a penile skin block and intracavernosal block to confirm the cavernosal tissue as the source of CC-EMG. Further refinement of this technique may render it useful in the evaluation of neurogenic impotence. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e806-e807 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Leddy Seattle, WA More articles by this author Xiaogang Jiang Seattle, WA More articles by this author Claire Yang Seattle, WA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Corpus cavernosum electromyography: could it be a parameter to predict ageing?

In this study, we investigated whether electromyography of corpus cavernosum (CC-EMG) results vary with age and whether CC-EMG could be a parameter to predict ageing of cavernous smooth muscle. Recordings of electrical activity of corpus cavernosum (EACC) were retrospectively investigated in 134 patients with erectile dysfunction. Penile colour Doppler ultrasonography and cavernosometry were also performed for all of the patients. The total number and duration of EACC and amplitudes between positive and negative peaks were compared between the flask state for 10 min and after intracavernosal papaverine injection. The mean age of the 47 patients in group 1 was 35.2 ± 6.3 years (range, 23-44), the mean age of the 45 patients in group 2 was 51.1 ± 3.1 years (range, 45-56) and the mean age of the 42 patients in group 3 was 61.8 ± 4.6 years (range, 57-77). Total IIEF-5 score was 7.6 ± 2.1 in group 1, 7.9 ± 2.4 in group 2 and 7.9 ± 2.1 in group 3. There were no statistically significant differences among the groups regarding electrical potential frequencies, durations and amplitudes of electromyographic recordings. We do not think that CC-EMG findings could be used efficiently as a predictor of ageing.

Brain potentials related to corpus cavernosum electromyography

The aim of this study was to elucidate the relation between electrical activity in the corpus cavernosum (CC), penile responses and brain processes. EEG potentials, penile circumference and electrical activity of the CC (CC-EMG) were recorded simultaneously while male subjects were exposed to visual sexual stimuli. The trials were sorted by the penile response of the subjects (erection, maintenance or detumescence). The corresponding EEG recordings were subjected to independent component analysis (ICA) and then correlated with CC activity. We found that CC activity was decreased in the case of erection. EEG activity was found to be correlated with CC activity in most cases at the same instant or with subsequent CC activity. EEG activity at early time points after stimulus onset (<300 ms) was found to be correlated with CC activity, indicating penile response preparation at a pre-attentive processing level. These data indicate that (i) CC activity is under the control of brain processing and (ii) autonomous input reaches the CC in fractions of a second after sexual stimulus onset. Our experimental paradigm should be used for the study of psychogenic erectile dysfunctions and could help in the development of an objective measurement of this disturbance.

Is deep dorsal vein arterialization effective in elderly patients?

Arterialization operations of the penis are recommended for young patients with erectile dysfunction (ED). In this study, we investigated the efficiency of deep dorsal vein arterialization (DDVA) in carefully selected healthy elderly patients An initial extensive evaluation with corpus cavernosum electromyography, cavernosometry, and penile doppler ultrasonography was performed for 43 elderly patients with ED for whom the presence of risk factors (hypertension, diabetes, hyperlipidemia, smoking habit, psychiatric or neurologic disorders, liver or kidney failure, and history of major trauma) had been ruled out. All patients underwent to DDVA using the Furlow-Fisher technique. Surgical outcome was tested postoperatively by use of the fifteen-item International Index of Erectile Function questionnaire (IIEF-15). Surgical success was assumed if the score in the five-item version of the IIEF (IIEF-5) had increased by at least five points. Of the patients, 21 were detected to have caverno-occlusive disease, 13 had arteriogenic disease, and 9 had both caverno-occlusive and arteriogenic disease. The mean age of the patients was 59.7+/-4.6 years and the mean follow-up time was 22.1+/-7.1 months. The operation was successful in 26 cases (60.5%) according to IIEF-5. Total IIEF-15 score was increased from 19.2+/-5.0 to 28.5+/-9.4 (P<0.05). Significant increases were observed in the erectile function, intercourse satisfaction, and overall satisfaction domains of IIEF-15. The preoperative degree of ED or the etiology of ED had no impact on the surgical results. Percent changes in the total IIEF-15 score and in its domains were no different between patients aged <60 and those aged >or=60. DDVA could successfully be performed for carefully selected elderly patients as long as the presence of risk factors for ED are ruled out.

Corpus Cavernosum Electromyography with Revised Methodology: An Explorative Study in Patients with Erectile Dysfunction and Men with Reported Normal Erectile Function

A lack of standardization of the recording techniques of corpus cavernosum electromyography (CC-EMG) and objective criteria to characterize the recorded signals (CC-potentials) are the main difficulties hindering the clinical application of this method. These difficulties have been recently overcome by revising the recording and interpretation methodology of CC-EMG AIM: To assess if CC-EMG performed with the revised methodology is discriminative for well-defined clinical conditions in patients with erectile dysfunction (ED). Based on blinded clinical diagnosis, ED patients were catalogued into five subgroups: severe penile fibrosis, cavernous arterial insufficiency (CAI), cardio-vascular comorbidity (CVCM) without proven CAI, post-radical retropubic prostatectomy (RRP), and psychogenic ED. With four electrodes placed on the penile shaft bilaterally, CC-EMG was recorded monopolarly for 30 minutes during flaccidity. After evaluation of the recordings by visual inspection, CC-potentials were analyzed using cross- and autocorrelation techniques. The parameters evaluated were amplitude, duration, dominant frequency (DF), and maximum cross-correlation coefficient (Rmax) of CC-potentials recorded from proximal and distal parts of the CC. Comparison of the values of parameters amplitude, duration, DF, and Rmax between patient and control groups. A total of 119 patients with ED and 43 men with reported normal erectile function were studied. Thirteen out of 14 patients with severe penile fibrosis did not show any distinguishable CC-potential. Patients with CAI had significantly decreased amplitude compared with the potent controls, as well as the patients with CVCM but without proven CAI. Significantly decreased amplitude and Rmax were detected in ED patients following RRP compared with the controls. Corpus cavernosum electromyography performed with the revised methodology is able to discriminate ED patients with conditions that are associated with cavernous smooth muscle degeneration and/or autonomic neuropathy from men with reported normal erectile function.

ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: A Reproducibility Study of Corpus Cavernosum Electromyography in Young Healthy Volunteers Under Controlled Conditions

Although the corpus cavernosum electromyography (CC-EMG) has been studied already for 16 years, doubts regarding its reproducibility have remained. To assess the reproducibility of CC-EMG under controlled conditions and the influence of confounding factors. Three CC-EMG recording sessions were performed in 13 healthy young men under the same conditions. Furthermore, the effects of potentially confounding factors, such as intake of caffeine, alcohol and smoking, and sexual activity, were investigated in the same population. Using auto- and cross-correlation techniques, CC-potentials were characterized with parameters amplitude (A), duration (D), dominant frequency (DF), maximum cross-correlation coefficient of longitudinal and bilateral CC-potential pairs (Rmax-lon. and Rmax-bi.), and propagation velocity (PV ). Comparison of CC-EMG parameters A, D, DF, Rmax-lon., and Rmax-bi. between three recording sessions and assessment of the impact of confounding factors on these parameters. DF, D, A, and Rmax-lon. showed significant correlations among three sessions; PV showed significant correlations between two sessions performed within the same day but not between those performed on different days; Rmax-bi. did not show significant correlations between any two sessions. Intake of caffeine, alcohol, and smoking did not affect CC-potentials, while the recordings shortly after ejaculation showed more irregular oscillations and less CC-potentials with smaller A. CC-potential parameters DF, D, A, and Rmax-lon. have been demonstrated to be reproducible. The results provide a basis for the clinical and scientific application of CC-EMG. CC-potentials are not sensitive to confounding factors such as intake of caffeine, alcohol, and smoking, while measurements shortly after ejaculation should be avoided.

The hypoactive corpora cavernosa with degenerative erectile dysfunction: a new syndrome.

BackgroundIn a group of 22 patients with erectile dysfunction, vasculogenic, neurogenic, endocrinologic or psychogenic investigations failed to find a cause for their erectile dysfunction. The electro-cavernosograms of these patients recorded a diminished activity. We investigated the hypothesis that diminished corpus cavernosum electromyography activity was the cause of erectile dysfunction in these patients.MethodsThe study comprised the above mentioned 22 patients (study group, 43.8 ± 5.9 SD years) and 15 healthy volunteers (control group, 41.8 ± 5.1 SD years). The electro-cavernosograms were recorded in the flaccid, erectile and detumescent phases by 2 electrodes inserted into the corpus cavernosum.ResultsThe electro-cavernosogram of the healthy volunteers registered in the flaccid phase regular slow waves and random action potentials. The wave variables declined significantly in the erectile phase (p < 0.01). In the study group, the slow wave variables in the flaccid phase exhibited a significant decrease (p < 0.05) compared to the healthy volunteers, and the rhythm was irregular. Erection did not occur with sildenafil administration or intracavernosal papaverine injection, and penile implant was performed. Biopsy examination showed degenerated muscle fibers, and fragmented collagen and elastic fibers with areas of fibrosis.ConclusionA novel concept of the cause of erectile dysfunction was presented. Corpora cavernosa showed degenerative changes on histopathologic examination and exhibited diminished electromyography activity. They did not respond to sildenafil administration or intracavernosal papaverine injection. Penile implants were the only treatment. The condition is given the name 'hypoactive corpus cavernosum'. The cause of corpus cavernosum degenerative changes needs further study.

Corpus cavernosum electromyography, a usable clinical diagnostic method for erectile dysfunction?

Corpus cavernosum electromyography (CC-EMG) has been intensively studied as a potential clinical tool for evaluating the function of the cavernous smooth muscle and its autonomic innervations since 1989. Both basic and clinical studies have shown promising results. However, its application as a diagnostic tool with clinical relevance was hindered by insufficient knowledge of cavernous smooth muscle electrophysiology and a series of technical and practical difficulties. Recently, major progress has been made to overcome these difficulties. Multichannel monopolar recording method has been proved to be superior to traditional one or two-channel bipolar recording. Correlation techniques have been applied as a comprehensive, objective and easy-to-use method to analyze CC-EMG recordings. Using these newly developed techniques, CC-EMG has been demonstrated to be discriminative in erectile dysfunction patients with conditions that are associated with cavernous smooth muscle degeneration and/or autonomic neuropathy from men with normal erectile function. However, before CC-EMG can be used as a robust method for erectile dysfunction-diagnostics, some basic and clinical issues are still to be solved. This review presents an overview of the latest advances in CC-EMG studies, mainly focusing on the clinical application of this method as a diagnostic tool. Furthermore, the background knowledge of cavernous electrophysiology, the problems to be overcome and future perspectives are also discussed.

CORPUS CAVERNOSUM ELECTROMYOGRAPHY DURING MORNING NAPS IN HEALTHY VOLUNTEERS: FURTHER EVIDENCE THAT CORPUS CAVERNOSUM POTENTIALS REFLECT SYMPATHETICALLY MEDIATED ACTIVITY

We assessed the practicability of corpus cavernosum (CC) electromyography (EMG) in volunteers during morning naps in the laboratory and further validated this method. A total of 11 healthy volunteers with a mean age of 23.8 years (range 19 to 31) were included. CC-EMG was started between 6:30 a.m. and 7 a.m. Two surface electrodes were placed at the base of the penis bilaterally and a reference electrode was placed on 1 kneecap. A strain gauge or Barlow gauge (Behavioral Technology, Salt Lake City, Utah) was used to monitor changes in penile circumference. Subjects were asked to sleep. Recording duration was 2 to 3 hours. Two recordings were performed per subject. Full erection was observed on 17 of the 22 recordings (77%), partial erection was noted on 3 (14%) and no tumescence was observed on the other 2 (9%). CC potentials consistently disappeared during tumescence and erection, while continuous CC potential oscillations reappeared during detumescence. During flaccidity bursts of CC potentials and electrical silence were recorded. Penile shrinkage was observed to accompany CC potentials but not to accompany electrical silence. CC-EMG during morning naps is a practical and valid method for investigating CC electrophysiology. CC-EMG signal patterns during tumescence, detumescence and flaccidity fit the existing theory that CC potentials reflect cavernous smooth muscle sympathetically mediated activity.

701Reproducibility of corpus cavernosum electromyography in healthy young men

Research on reproducibility of corpus cavernosum electromyography (CC-EMG) is relevant because reproducible signals indicate a biological phenomenon and not an artefact. Reproducible signals are also required to use CC-EMG as a diagnostic tool for erectile dysfunction. The aim of this study was to assess the reproducibility of CC-EMG in healthy young men under well-controlled conditions.