Loss Of Erectile Function Research Articles

Immediate impotence after penetrating perineal trauma: Restoration of erections with penile artery revascularization, corpus cavernosum aneurysm repair, and deep penile venous l1gation

Erectile dysfunction can result from blunt or penetrating pelvic or perineal trauma. Rupture of the corpora cavernosa leading to loss of the veno-occlusive mechanism and penile artery occlusion have been found in these patients. We present a case of immediate loss of erectile function after penetrating perineal trauma resulting in corpus cavemosum rupture and traumatic occlusion of multiple arteries in the hypogastric-cavernous bed. Conservative management of the corpus injury resulted in post-traumatic aneurysmal dilation at the site of injury with venous leakage from aberrant veins. Penile arterial revascularization and aneurysm repair with deep penile venous ligation resulted in near-complete return of normal erectile function.

Results of Surgical Management of Peyronie’s Disease

Peyronie’s disease is often managed surgically when medical management fails and sexual function is impaired due to residual curvature or loss of erectile function. In this study 63 patients were treated surgically, with 25 receiving a penile prosthesis, 25 undergoing a tunica vaginalis graft and 13 undergoing the Nesbit ellipse procedure. The long-term surgical outcome as determined by sexual function indicated that the penile prosthesis group remained the most sexually active, followed by the Nesbit ellipse group with the tunica vaginalis graft group being the least sexually active. Incision of curvature with placement of a penile prosthesis for the surgical management of Peyronie’s disease remains an approach that has excellent long-term functional results.

Transpubic Urethroplasty in Children

In 12 children with membranous urethral strictures transpubic urethroplasty has been performed successfully with minimal morbidity and no mortality. Of the 12 patients 8 are completely continent after transpubic urethroplasty, 2 have partial continence and 2 are incontinent. Wedge resection of the pubic symphysis afforded satisfactory exposure to the prostatic urethra, and none of the 12 patients experienced orthopedic instability, abnormal gaits or pelvic girdle pain. In 3 patients there was loss of erectile function after pelvic injury, which reflects the significant risk of impotence after crush injury to the pelvis with rupture of the posterior urethra.

Causes of erectile dysfunction

Normal male erection depends upon a combination of factors including normal cortico-sensory perception, intact spinal pathways, normal parasympathetic and sympathetic peripheral nerve innervation, normal blood supply, both arterial and venous to the penis and normal corpora cavernosa. It is obvious, therefore, that disturbances in any of the above components might result in loss of erectile function. It is useful for the clinician to try to identify the cause of erectile function in a particular patient. While these basic anatomic pathways are the prerequisite for normal male sexual function, they in turn depend upon specific hormonal and biochemical support for their integrity.