Penile Arteries Research Articles

The Effect of Physiotherapy on Erectile Dysfunction Secondary to Prostatic Adenectomy: A Randomized Control Trial Study.

The objective of this randomized controlled trial was to investigate the impact of manual therapy (friction massage) and pelvic floor muscle (PFM) training on erectile dysfunction (ED), pelvic floor muscle thickness, and blood flow in the penile arteries and veins in men who have undergone prostatic adenectomy (PA). This study employed a randomized, double-blinded, controlled trial design. Forty patients participated and were divided into two groups: intervention and control (n=20 per group). The intervention group received 10 sessions of pelvic floor muscle training and manual therapy, while the control group solely underwent pelvic floor muscle training. The recovery rate was measured using the International Index of Erectile Function 15 (IIEF-15) questionnaire and Erection Hardness Score (EHS). Sonographic factors were assessed using simple and Doppler ultrasound. The intervention group exhibited significantly higher erectile function scores (F(1,37)=158.04, P < 0.001, η2 P = 0.810) and a higher average total (IIEF-15) score (20.52) (F(1,37)=136.76, P < 0.001, η2 P = 0.787) compared to the control group in the post-test assessment. Comparison between the two groups revealed an increase in ultrasonic parameters such as the thickness of the ischiocavernosus and bulbospongiosus muscles, maximum systolic velocity, and minimum diastolic velocity of the cavernosal artery in the intervention group. However, the maximum blood flow velocity in the posterior vein decreased. PFM training and friction massage play a significant role in managing ED following PA, positioning them as the primary treatment approach for men experiencing ED post-prostatectomy.

(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.

Dorsal Penile Artery Avulsion After Collagenase Clostridium histolyticum (Xiaflex) for Peyronie’s Disease: A Case Report

Collagenase Clostridium histolyticum (CCH) is frequently used as first-line therapy for patients with Peyronie’s disease. It was United States Food and Drug Administration approved in 2013 and since then, has been widely accepted as a safe and effective treatment option with most adverse effects being minor and amenable to conservative management. We report an unusual and previously unreported complication after CCH (Xiaflex) injection: avulsion of a dorsal penile artery, which required surgical exploration and ligation. This article seeks to inform urologists about an unexpected complication that should be considered in the differential diagnosis for severe penile hematoma after CCH injection and discusses our strategy for surgical management.

Endovascular penile revascularization improves erectile dysfunction in patients with penile arterial insufficiency

In most institutions, patients with erectile dysfunction due to penile arterial insufficiency are offered palliative treatments like vacuum constrictor devices, intraurethral alprostadil, intracavernosal injection of prostaglandins, and/or implantation of penile prosthesis when these patients can be treated by endovascular penile revascularization. 50% of patients with erectile dysfunction are non-responders to phosphodiesterase-5 inhibitors. 70% of non-responders to phosphodiesterase-5 inhibitors have penile arterial insufficiency that can be treated with endovascular penile revascularization. Patients who are non-responders to phosphodiesterase-5 inhibitors should be screened for penile arterial insufficiency using penile duplex scan. If penile artery peak systolic velocity is &lt;35 cm/s, then arterial insufficiency is suspected, and computed tomography (CT) angiogram is obtained to confirm presence of significant stenosis in iliac-pedundle-penile arterial system. Patients with penile arterial insufficiency should be offered endovascular penile revascularization. This minimally invasive procedure has minimal perioperative complications (&lt;1%) and has significant clinical improvement in erectile function in &gt;60% of patients at 12 months. Endovascular penile revascularization is safe and has long term clinical improvement in erectile function. This minimally invasive procedure can result in improved erectile function and preserves penile size and shape in most non-responders to phosphodiesterase-5 inhibitors.

Prevalence of Erectile Dysfunction among Patients with Coronary Artery Disease

Both coronary artery disease (CAD) and erectile dysfunction (ED) are widespread illnesses that frequently coexist. Numerous triggering risk factors and pathophysiological mechanisms contribute to both diseases. Penile color Doppler ultrasound can serve as a crucial tool to evaluate penile arterial blood flow. Therefore, this study aims to assess the ED prevalence in CAD patients, to determine the socioeconomic and clinical profiles of the population, and to define risk factors of their development. The cross-sectional study included 100 male patients who were admitted to the coronary angiography (CAG) unit. Patients were asked if they had ED, and if present, it was graded using the International Index of Erectile Function 5. Right and left cavernosal arteries were examined using color Doppler and erection hardness to assess the peak systolic velocity (PSV) and end-diastolic velocity. Among the 52 cases that suffered from ED, most of the cases had mild grades (38.5%). All cases without ED (100%) had penile artery Doppler PSV findings ≥30 (cm/s) with an average Doppler PSV of 48.02 ± 7.49 cm/s for the right cavernosal arteries and 47.4 ± 7.17 cm/s for the left cavernosal arteries. Yet, 71.2% of cases with ED had penile artery Doppler PSV findings &lt;30 (cm/s) with an average Doppler PSV of 29.1 ± 7.57 cm/s for the right cavernosal arteries and 28.69 ± 7.11 cm/s for the left cavernosal arteries. Furthermore, by CAG, 50% of cases without ED had blockage not necessitating a coronary intervention (no significant disease) compared to 25% of cases with ED. There was positive correlation between advanced grade of ED and age (r = 0.327, P &lt;0.001), hypertension (r = 0.213, P = 0.033), DM (r = 0.253, P = 0.011), smoking (r = 0.202, P = 0.044), and severity of CAD (r = 0.332, P &lt;0.001). Patients with multivessel CAD have a significantly higher incidence and more severity of ED. Moreover, pathological penile vessels PSV (&lt;25 or &lt;30 cm/s) via Doppler ultrasound is mostly valuable as a noninvasive tool to define ED attributable to vascular impairment that may be antecedent to atherosclerosis in the coronary vessels.

Activation of mitoKATP channels induces penile vasodilation and inhibits mitochondrial respiration and ROS production: Role of NO

ObjectiveMitochondrial ATP-sensitive K+ (mitoKATP) channels are involved in neuronal and cardiac protection from ischemia and oxidative stress. Penile erection is a neurovascular event mediated by relaxation of the erectile tissue via nitric oxide (NO) released from nerves and endothelium. In the present study, we investigated whether mitoKATP channels play a role in the control of penile vascular tone and mitochondrial dynamics, and the involvement of NO. MethodsThe effect of the selective mitoKATP activator BMS191095 was examined on vascular tone, on mitochondrial bioenergetics by real-time measurements with Agilent Seahorse and on ROS production by MitoSOX fluorescence in freshly isolated microarteries. ResultsBMS191095 and diazoxide relaxed penile arteries, BMS191095 being one order of magnitude more potent. BMS191095-induced relaxations were reduced by mechanical endothelium removal and by inhibitors of the nitric oxide synthase (NOS) and PI3K enzymes. The NO-dependent component of the relaxation to BMS191095 was impaired in penile arteries from insulin resistant obese rats. The blockers of mitoKATP channel 5-HD, sarcolemma KATP (sarcKATP) channel glibenclamide, and large conductance Ca2+-activated K+ (BKCa) channel iberiotoxin, inhibited relaxations to BMS191095 and to the NO donor SNAP. BMS191095 reduced the mitochondrial bioenergetic profile of penile arteries and attenuated mitochondrial ROS production. Blockade of endogenous NO impaired and exogenous NO mimicked, respectively, the inhibitory effects of BMS191095 on basal respiration and oxygen consumed for ATP synthesis. Exogenous NO exhibited dual inhibitory/stimulatory effects on mitochondrial respiration. ConclusionsThese results demonstrate that selective activation of mitoKATP channels causes penile vasodilation, attenuates ROS production and inhibits mitochondrial respiration in part by releasing endothelial NO. These mechanisms couple blood flow and metabolism in penile arterial wall and suggest that activation of vascular mitoKATP channels may protect erectile tissue against ischemic injury.

(015) Comparison of Penile Arterial Doppler-Ultrasound and Coronary Computed Tomography Angiography (CCTA) to Improve Cardiovascular Risk Assessment in Patients with Erectile Dysfunction

Abstract Introduction Erectile dysfunction (ED) has been shown to be an independent and early marker of future cardiovascular events, providing an important window of opportunity for cardiovascular preventive measures. However, there are several etiologies for ED (arterial, venous, hormonal, neurological, psychological), and earlier studies have not taken etiology into account when assessing cardiovascular risk. Arterial ED etiology share risk factors and pathophysiologic mechanisms with coronary and neurovascular diseases. Therefore, it can be assumed that patients with ED with arterial (atherosclerotic) etiology have a higher risk of future cardiovascular events than the general ED population. Objective To evaluate the predictive value of penile artery Doppler ultrasound (DUS) in cardiovascular risk assessment by comparing it with coronary atheroma screening by Coronary computed tomography angiography (CCTA) in patients with erectile dysfunction. Methods Men under 70 years of age, with ED and at least 1 cardiovascular risk factor (hypertension, dyslipidemia, diabetes, smoking, metabolic syndrome, obesity) were included. Patients with a primary cardiovascular event were excluded. Every patient had a penile DUS to assess penile arterial disease based on the maximum systolic velocity of the carvernous arteries after stimulation by intracavernous injection (A-Score), and a CCTA to assess coronary atheromatous arterial disease (CAD-RADS score). Results From October 2022 to June 2023, 72 consecutive patients were included. Mean age was 55 +/- 8.6 years. Mean IIEF5 score was 11 +/-5.3. N=34 (30%) were smokers, n=24 (33%) had hypertension, n=27 (37.5%) had diabetes, n=9 (11.1%) had obesity, n=10 (13.9%) had dyslipidemia. On penile artery DUS assessment n=62 (86%) patients had a positive A-Score. On CCTA, CAD-RADS scores were 0 in n=13 (18%) patients, 1 in n=18 (25%), 2 in n=19 (26%), 3 in n=17 (24%), and 4 in n=5 (7%) patients. We then analyzed the predictive value of A-Score as follows: 1. patients with coronary atheromatous plaques on CCTA (CAD-RADS ≥1, n=59), were significantly more likely to have a positive A-Score (n=56, 94.9%) than negative A-Score (n=13, 18%, p&amp;lt;.001, Chi2-test). The positive predictive value of the A-Score indicating penile arterial disease for the presence of coronary plaque, was 90.3%. 2. Patients with significant coronary stenosis (CAD-RADS ≥3, n=22) all patients n=22 (100%), had a positive A-Score and none a negative test (p=.026). The positive predictive value of the A-Score for the presence of significant coronary stenosis on CCTA was 100%. Conclusions The penile artery Doppler ultrasound A-Score has a good predictive value for coronary atheromatous artery disease in patients with erectile dysfunction, and allowed us to identify a sub-population at higher cardiovascular risk. When the A-Score is positive, the presence of coronary plaque is highly probable; when it is negative, the presence of significant coronary stenosis is highly unlikely. Disclosure No.

(315) Evidence Analysis for Contemporary Vascular Therapies for Erectile Dysfunction

Abstract Introduction Erectile Dysfunction (ED) is a common male sexual disorder that is caused by various conditions including vascular dysfunction. Different treatment options can be implemented, like lifestyle modifications, pharmacological intervention, or surgical procedures. In select ED cases, vascular procedures such as penile revascularization and venous ligation could be an alternative option. Objective We herein evaluated the current evidence and outcomes of penile revascularization, venous ligation and other vascular surgery with specific emphasis on complications and patients’ satisfaction. Methods A literature search was conducted using PubMed and Google Scholar to examine papers from 1993 to present day. Keywords, such as, “Erectile dysfunction”, “ED vascular surgery”, “Penile venous ligation”, “Penile revascularization”, and “Arterial bypass surgery”, were used in this search. All the papers were in the English language. Results A total of four studies met inclusion criteria for penile arterial bypass and dorsal penile venous ligation procedures with erectile function, clinical outcomes, satisfaction rates and post operative complications. Regarding penile arterial bypass, two studies identified. First study reported inferior epigastric artery (IEA) to the penile dorsal artery of 1500 patients reported success rates of erectile function were 67% and satisfaction rates of 89%. Postoperative complications were anastomotic disruption, penile skin sensation loss and pain. Regarding venous ligation of penile dorsal vein, two studies identified. First study of 100 patients reported success rates of erectile function were 62% at 1 year. Second study of 26 patients reported success rates of erectile function were 42.3% and satisfaction rates of 57.7% at 3.7 years. Postoperative complications were painful erections, skin necrosis, and penile shortening (Table 1). Conclusions Vascular therapies including penile arterial bypass and penile dorsal venous ligation for ED could provide improved clinical outcomes and satisfactions in select patients’ population. Future studies are warranted to further evaluate its surgical outcomes and long-term safety and efficiency. Disclosure No.

Analysis of vacuum negative pressure therapy and traditional Chinese medicine lavage in combination with tadalafil for vascular erectile dysfunction.

This study investigates the clinical effects of the novel Traditional Chinese Medicine (TCM) topical wash used in combination with negative pressure irrigation and tadalafil for the treatment of vascular erectile dysfunction. Eighty-seven patients with vascular erectile dysfunction were divided into an observation group and a control group. The observation group was administered negative pressure irrigation (TCM) in combination with oral tadalafil for four weeks, and the control group was administered oral tadalafil for four weeks. The observation group included 21 patients with arterial erectile dysfunction and 22 with intravenous erectile dysfunction. After treatment, IIEF-5, EHS, GAD scores, PSV, EDV and RI in observation group were improved compared with those before treatment (P = 0.000, 0.000, 0.000, L0.000/R0.000, L0.000/R0.000, L0.003/R0.000). Erectile function (IIEF-5, EHS) was significantly improved compared with the control group (P = 0.008, 0.002). In the observation group, there were 21 cases of arterial erectile dysfunction and 22 cases of intravenous erectile dysfunction. After treatment, PSV of arterial ED improved significantly (P = L0.000/R0.000), but EDV did not decrease significantly (P = L0.084/R 0.098). In patients with venous ED, PSV increased (P = L0.026/R0.032) and EDV decreased significantly (P = L0.000/R0.000). These findings suggest that TCM negative pressure lavage combined with tadalafil improves the blood supply of the penile artery, relaxes smooth muscle, and improves the closing mechanism of venous vessels in patients with vascular erectile dysfunction, ultimately improving the erectile function.

Hazardous Effects of Electrocautery on Penile Arteries: An Experimental Study

Hazardous Effects of Electrocautery on Penile Arteries: An Experimental Study

Can atherogenic indices and the triglyceride-glucose index be used to predict erectile dysfunction?

Atherosclerosis and insulin resistance play an important role in the development of erectile dysfunction (ED), and few studies have comprehensively evaluated more specific indicators like atherogenic indices and the triglyceride-glucose (TyG) index in the assessment of ED. This study aimed to reveal the role of atherogenic indices (atherogenic index of plasma [AIP], Castelli risk index-1/2 [CRI-1/2], and atherogenic coefficient [AC]) based on plasma lipid ratios, which have been used as more sensitive indicators of atherosclerosis in recent years, and the TyG index, a practical indicator of insulin resistance, in predicting vasculogenic ED. The study included a total of 199 patients who met the inclusion criteria and a total of 51 control subjects without ED complaints according to the International Index of Erectile Function (IIEF-5) scores (>21) between May 2021 and October 2022. For all participants, the demographic and biochemical parameters were evaluated, and atherogenic indices, namely CRI-1 (total cholesterol/high-density lipoprotein [HDL]), CRI-2 (LDL/HDL) AIP [log10(triglycerides/HDL)], and AC (non-HDL/HDL), as well as the TyG index [Ln {fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2}] were calculated. The TyG index, which is an indicator of insulin resistance, and atherogenic indices such as CRI-1, AIP, and AC were significantly associated with ED, and especially AIP and the TyG index seem to be more important in the evaluation of ED. According to the univariate analysis, the patient group had significantly higher CRI-1 (5.3 ± 1.4 vs 4.7 ± 1.3; P = .005), AIP (0.31 ± 0.26 vs 0.13 ± 0.2; P < .001), AC (4.1 ± 1.4 vs 3.70 ± 1.2; P = .026), and TyG (9.16 ± 0.71 vs 8.77 ± 0.52; P < .001) values compared with the control group. In the correlation analysis, a significant negative correlation was found between the AIP and TyG index and the IIEF-5 scores (r2 = 0.120, P < .001 between AIP and IIEF-5; r2 = 0.091, P < .001 between TyG index and IIEF-5). The multivariate analysis revealed AIP and the TyG index as independent predictive factors for ED. The use of atherogenic indices and TyG index in daily urology practice can help physicians in the diagnosis and follow-up of ED. The lack of sex hormone-binding globulin and free testosterone levels represents a limitation of our study. Another limitation is that the severity of ED was determined using the IIEF-5 scores, rather than a more objective method, such as penile artery ultrasound. Atherogenic indices and the TyG index can be used as inexpensive and practical markers to predict the severity of arteriogenic ED.

Arterial stiffness, blood pressure progression and penile vascular disease in males with erectile dysfunction: a closer look at microcirculatory damage

Abstract Background Elevated aortic stiffness may be associated with microvascular remodelling and damage, which may be an important causal contributor to incident cardiovascular disease. Recent evidence supports the independent of age and blood pressure (BP) level predictive value of severe penile arterial insufficiency for adverse cardiovascular events. Purpose Aim of the study is to examine in men with erectile dysfunction the association of increased aortic stiffness with penile vascular damage by taking into account BP level. Methods We measured carotid-femoral pulse wave velocity (PWV) and assessed microvascular (penile vascular damage) changes in four age-matched groups without a history of diabetes and cardiovascular disease; Normal BP (n=137), high-normal BP (n=94), stage I hypertension (n=82) and stage II and III hypertension (n=76). Microvascular damage was examined by measuring penile peak systolic velocity (PSV) with a dynamic penile color Doppler ultrasonography after intracavernous injection of prostaglandin E1. Lower PSV values indicate severe penile vascular disease. Results Carotid-femoral PWV increased and PSV decreased across BP groups (all P&amp;lt;0.001). In regression analysis increased systolic BP (b= -0.185, P&amp;lt;0.01) and PWV (b= -0.170, P&amp;lt;0.05) are significant determinants of low penile PSV after controlling for age, body mass index, cholesterol and smoking. We dichotomized carotid-femoral PWV taking into account the mean value in the whole study population. Figure shows the differences in PSV across the BP groups considering the cut-off PWV value of 8.5m/s (high vs low PWV). Individuals with higher PWV had lower penile PSV in normal BP (P&amp;lt;0.01) and in high normal BP group (P=0.02) after adjusting for age and systolic BP. On the contrary, hypertensive patients already have significant structural damage in the penile arteries and high PWV does not further reduce penile blood flow. Interestingly, figure shows the comparable PSV measurements between individuals with high-normal BP level who had high PWV and patients in stage 1 hypertension group denoting significantly impaired microvascular damage in males with high-normal BP and increased aortic stiffness. The high normal BP group has significantly lower PSV compared to normal BP group independently of PWV value. Conclusion Increased aortic stiffness may promote penile microvascular remodelling and damage in men without increased BP level. Additionally, in men with high-normal BP higher arterial stiffness is associated with comparable penile microvascular damage of men with arterial hypertension. Because aortic stiffening may be preventable, further clinical research on earlier preventive measures that focus on aortic stiffness and microvascular remodelling within individuals with erectile dysfunction who have normal BP is warranted.Aortic stiffness, BP level and PSV

Use of Phosphodiesterase Inhibitors in Patients with Penile Artery Occlusion

Penile artery occlusion is a vascular condition that can lead to erectile dysfunction, significantly affecting a patient's quality of life and psychological well-being. This comprehensive review explores the epidemiology and clinical significance of penile artery occlusion, emphasizing the substantial impact it has on patients' sexual health. The theoretical framework delves into the definition of penile artery occlusion, identifies risk factors contributing to its development, discusses potential complications, and outlines current management strategies. The discussion section evaluates the use of phosphodiesterase inhibitors as a therapeutic approach in patients with penile artery occlusion, providing insights into their mechanisms of action, efficacy, and safety. The conclusion emphasizes the importance of a personalized approach to managing this condition, with phosphodiesterase inhibitors as a valuable option.

Serum folic acid: an effective indicator for arteriogenic erectile dysfunction.

The present study is the first to explore the correlation between serum folic acid (FA) level and penile arterial peak systolic velocity (PSV) as measured via penile color Doppler ultrasonography (PDU), which directly reflects endothelial function in the penile artery. A total of 244 consecutive erectile dysfunction (ED) patients and 72 healthy controls, recruited from the Andrology department and the Healthy Physical Examination Center of our hospital, respectively, from June 2020 to April 2022, were included in the study. Serum FA was measured in ED patients and healthy controls, and PDU examinations were conducted for all eligible ED patients. The Pearson method was used to evaluate the correlation between FA levels and PDU parameters in ED patients. A receiver operating characteristic (ROC) curve analysis was also performed to calculate the sensitivity and specificity of these parameters for prediction of arteriogenic ED. After the PDU test, the average serum FA level among patients diagnosed with arteriogenic ED was 8.08 ± 2.64 ng/ml, lower than the average of 10.78 ± 2.87 ng/ml among healthy controls. There were no statistically significant inter-group differences on any basic parameters, including age, body mass index, fasting blood glucose, total cholesterol, and triglyceride. For further analysis, we divided the arteriogenic ED group into three subgroups by PSV range to compare serum FA levels among these subgroups. The mean FA levels in each of these groups were 5.97 ± 1.51ng/ml, and 8.21 ± 2.37ng/ml, and 10.55 ± 2.56ng/ml, while the corresponding PSV values were 15.75 ± 2.39cm/s, 23.53 ± 2.19cm/s, and 32.72 ± 1.64cm/s. Overall, a positive correlation between PSV and FA level was found among patients with arteriogenic ED (r=0.605, P<0.001). Furthermore, when FA level was used, with a cut-off value of 10.045 ng/ml, as a criterion to distinguish patients with arteriogenic ED from healthy controls, the area under the curve (AUC) was 0.772 (95% confidential interval: [0.696, 0.848]), for a sensitivity of 0.611 and specificity of 0.824. Serum FA level is positively correlated with PSV in ED patients, and has the ability to distinguish patients with arteriogenic ED from healthy controls. Taking these findings together, FA deficiency should be regarded as an independent risk factor for arteriogenic ED.

(231) Endogenous Vasoactive Peptides in the Control of Human Penile Erectile Tissue: Is There a Significance of the Neuropeptide Y (NPY)?

Abstract Introduction Aside from the neurotransmitters of the sympathetic adrenergic system, vasoconstrictor peptides may also play a role in mediating the constant tone of the erectile tissue during penile flaccidity and in returning the erect penis to the flaccid state. Neuropeptide Y (NPY) is present in high concentrations in the male genital tract. The peptide has been shown to induce contraction of isolated human penile tissue (corpus cavernosum, penile arteries) and potentiate its response to noradrenaline. Objective The purpose of our study was to measure in the cavernous and systemic blood of healthy male volunteers the course of NPY through different stages of sexual arousal. Methods Whole blood was drawn from the corpus cavernosum and the cubital vein of 15 healthy male volunteers during penile flaccidity (Fl), tumescence (Tu), rigidity (Ri) and detumescence (Det). Penile tumescence and erection were induced by applying audiovisual and tactile stimulation. Plasma levels of NPY (given in pmol/L) were determined by means of an enzyme-linked immunoassay (ELISA, IBL GmbH, Hamburg, Germany). Results NPY significantly decreased in the cavernous blood with the beginning of sexual arousal, when the flaccid penis became tumescent and finally rigid (Fl: 88.8 ± 35.8, Tu: 62.4 ± 22.7, Ri: 62.3 ± 19.7). In the phase of detumescence, only a slight increase was noted (64.8 ± 23). In the systemic circulation, no pronounced alterations in the concentration of NPY were registered through the different penile stages (Fl: 64.4 ± 27, Tu: 65.8 ± 19, Ri: 59.6-25, Det: 67.6 ± 29.3). Conclusions Our findings are in favor of the hypothesis that NPY could contribute to the maintenance of the resting state of cavernous smooth muscle. It remains to be elucidated whether the peptide may play a role in the pathophysiology of erectile dysfunction. Disclosure No

(439) Penile Revascularization Utilizing The Lateral Femoral Circumflex Artery After Pelvic Fracture Urethral Injury

Abstract Introduction Pelvic fracture urethral injury (PFUI) is associated with erectile dysfunction (ED) in up to 62% of patients, often due to decreased arterial inflow. For select healthy patients with isolated arterial insufficiency, penile revascularization utilizing the inferior epigastric artery to either the cavernosal or dorsal penile artery has been shown to be an effective treatment ED. The patient originally presented with a PFUI after a motor vehicle collision. He underwent suprapubic tube placement and selective embolization of a right internal pudendal artery pseudoaneurysm. Four months later, he underwent a posterior urethroplasty with corporal splitting and inferior pubectomy. During follow-up, he reported no erectile function following his initial trauma with no prior history of erectile dysfunction. He was trialed on PDE5is which were ineffective and ICI which was discontinued due to pain and minimal efficacy. Penile Doppler ultrasound with ICI showed bilateral arterial insufficiency with peak systolic velocities of 11.3 and 18.8 cm/second and no evidence of veno-occlusive dysfunction with end-diastolic flows of 2.85 and 4.66 cm/second of the cavernosal arteries (Figure 1). Bilateral inferior epigastric arteriography demonstrated 20-30% ostial stenosis with left traumatic occlusion of the internal pudendal and complete occlusion of the right internal pudendal artery post-embolization. The dorsal penile arteries filled in a delayed fashion via small-caliber collaterals. Objective We present this case to demonstrate use of an alternative arterial donor vessel for penile revascularization. Methods An infrapubic incision was made to expose the right dorsal penile artery. Another incision was made from the right anterior superior iliac spine to just above the patella tendon. The rectus femoris and vastus lateralis were atraumatically split and the descending branch of the lateral femoral circumflex artery was exposed. Small branches were clipped (Figure 2). The most distal branch to the rectus femoris was divided to become the donor vessel, leaving the proximal branch to maintain muscular perfusion. The donor branch was mobilized and passed via a subcutaneous tunnel into the infrapubic incision (Figure 3). Using an operating microscope the dorsal penile artery was ligated and the distal end was anastomosed to the donor artery and an end-to-end fashion using 8-0 nylon interrupted sutures. A drain was placed in the thigh wound, and both wounds were closed in two layers. Results The patient was started on 325mg of daily aspirin and remained on bed rest for two days. He was discharged on postoperative day two and his thigh drain remained in place for two weeks. He was restricted to less than 30-degree abduction of the right thigh for four weeks. Four months postoperatively the patient was achieving erections with 7/10 rigidity using only 5mg of tadalafil as needed. His SHIM was 17. At six months postoperatively he had increased his tadalafil dose to 20mg and was achieving erections with 8/10 rigidity from his pre-injury baseline. Conclusions This case demonstrates an excellent result from penile revascularization utilizing the lateral femoral circumflex artery. This artery can be considered an alternate donor for penile revascularization procedures following pelvic fracture urethral injury when there is a contraindication to the use of the inferior epigastric artery. Disclosure No

MP02-01 CADAVERIC PENILE DISSECTION AND ITS IMPACT ON LIVE DONOR PENILE TRANSPLANTATION: A PRELIMINARY STUDY

You have accessJournal of UrologyCME1 Apr 2023MP02-01 CADAVERIC PENILE DISSECTION AND ITS IMPACT ON LIVE DONOR PENILE TRANSPLANTATION: A PRELIMINARY STUDY Borko Stojanovic, Bojana Radnic, Marta Bizic, Milenko Bogdanovic, Sinisa Ducic, Vesna Popovic, Tatjana Atanasijevic, and Miroslav Djordjevic Borko StojanovicBorko Stojanovic More articles by this author , Bojana RadnicBojana Radnic More articles by this author , Marta BizicMarta Bizic More articles by this author , Milenko BogdanovicMilenko Bogdanovic More articles by this author , Sinisa DucicSinisa Ducic More articles by this author , Vesna PopovicVesna Popovic More articles by this author , Tatjana AtanasijevicTatjana Atanasijevic More articles by this author , and Miroslav DjordjevicMiroslav Djordjevic More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile transplantation presents an ideal treatment for penile agenesis, traumatic penile amputation, penile cancer or gender dysphoria in transmen. Until now, all four reported cases underwent cadaveric penile transplantation. We evaluated possibilities for using all penile entities after their removal in transfemale gender affirming surgery for live donor penile transplantation. Main goal of this cadaveric study was to develop techniques for anatomical harvesting of the penile entities (corpora cavernosa with distal urethra and glans) that could be used for safe and successful donor penile transplantation. METHODS: Between January and September 2022, penile dissection was performed in 18 male cadavers, aged from 19 to 51 years (mean 38.5 years). Dissection was based on penile disassembly principles: corpora cavernosa with urethra, glans with neurovascular bundle and penile skin. Penile skin with small piece of the glans and proximal urethra were separated as a tissue for creating the female genitalia. This way completely preserved cavernosal bodies, distal urethra and largest part of the glans were precisely measured with associated blood vessels and nerves. RESULTS: Mean penile length was 10.5 cm (from 6 to 13 cm) in flaccid and 15 cm (from 12 to 18 cm) in stretched state, and mean circumference 8 cm (from 7 to 9 cm). Neurovascular bundle had regular anatomy in 16 cases, while in remaining 2 anatomical variations were detected: single penile artery in one and a common trunk of both penile arteries in another case. Mean diameters of deep dorsal vein, right and left left artery were measured 2.9 mm, 2.5 mm and 2.2 mm, respectively. Penile nerves were found in all cases with anatomical distribution. A circumflex branches and perforators of the blood vessels were detected in all cases. Mean length and girth of cavernosal bodies were 20 cm (from 18 to 24 cm), and 7.4 cm (from 6.5 to 11 cm), respectively. Both crural arteries are identified in all cases. Mean length of the distal urethra was 11.4 cm (from 9.5 to 14 cm) without registered anomalies. The mean volume of the remaining glans after creation of the neoclitoris was 87% (from 85 to 90%). All dissections were finished successfully, and all entities were joined again in all cadavers. CONCLUSIONS: Preliminary results of cadaveric penile dissection confirm feasibility of using all remaining entities such as corpora cavernosa, minimally reduced glans, distal urethra and preserved neurovascular elements during transfemale gender affirming surgery for possible penile transplantation. Surgical technique is suggested and will be established with further research. Source of Funding: Science Fund of the Republic of Serbia, Project IDEAS © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e10 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Borko Stojanovic More articles by this author Bojana Radnic More articles by this author Marta Bizic More articles by this author Milenko Bogdanovic More articles by this author Sinisa Ducic More articles by this author Vesna Popovic More articles by this author Tatjana Atanasijevic More articles by this author Miroslav Djordjevic More articles by this author Expand All Advertisement PDF downloadLoading ...

PD35-09 VESSEL-SPARING NON-TRANSECTING ANASTOMOTIC RECONSTRUCTION OF THE POSTERIOR URETHRA: LONG-TERM FOLLOW-UP

You have accessJournal of UrologyCME1 Apr 2023PD35-09 VESSEL-SPARING NON-TRANSECTING ANASTOMOTIC RECONSTRUCTION OF THE POSTERIOR URETHRA: LONG-TERM FOLLOW-UP 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.0000000000003333.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The classic transecting excision and primary anastomosis (EPA) for reconstruction of posterior urethra stenosis (PUS) entails division of the bulbar arteries. Consequently, irrigation of the spongiosum will depend on the dorsal penile arteries and retrograde flow from the glans. However, if the penile arterial blood supply is compromised, transection may result in ischemia of the bulb and failure of the reconstruction. To decrease this risk, we modified the EPA technique avoiding urethral transection to preserve the bulbar arteries. We report our long-term results with this vessel-sparing posterior EPA approach (vspEPA). METHODS: Surgical Technique. The bulbar urethra is mobilized in a non-transecting fashion by division of the triangular ligament without detachment of the bulb from the perineal body. Distal release and lateral retraction of the bulbar urethra to one side with two vessel loops provides sufficient room for scar removal and anastomosis as with the classic transecting technique. In most cases both bulbar arteries can be spared, but in front of severe local fibrosis, division of one artery may be necessary to remove the scar, preserving the contralateral artery. RESULTS: Since April 2008, 115 patients with PUS received a vspEPA at our institution. The patients had a bulbo-membranous stenosis (n=91, 79%), prostate-membranous stenosis (n=11, 10%), or bulbo-vesical stenosis (n=13, 11%). Median age was 60 years (range 15-83) and median stenosis length was 2.5 cm (range 1-6), Sixty-two patients (54%) had a complete urethral obliteration. Bulbar artery preservation was unilateral in 57 and bilateral in 58. Median operative time was 170 min (range 70-265) and median estimated blood loss was 300 cc (range 50-2,000). A bulbo-membranous anastomosis was performed in 48 patients (42%), bulbo-prostatic in 54 (47%) and bulbo- vesical in 13 (11%). With 47 months of median follow up (range 5-146), vspEPA was successful in 109 patients (95%). Complications occurred in 34 (30%) patients but only 6 (5%) of them were Clavien grade ≥III. CONCLUSIONS: This vspEPA technique is feasible and safe and since 2008 it is our standard approach for anastomotic urethroplasty at the posterior urethra. We believe that vascular preservation may improve the outcome of reconstruction and our results are meaningful and highly encouraging. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e977 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 ...

V08-07 FREE GRAFT + PEDICLED TUBE IN BULBAR NECROSIS: HOW TO MAKE IT WORK

You have accessJournal of UrologyCME1 Apr 2023V08-07 FREE GRAFT + PEDICLED TUBE IN BULBAR NECROSIS: HOW TO MAKE IT WORK Pankaj Joshi, Cora Fogging, Daniel Gomez, Apurva Anand, Rateesh Rajendran, Shreyas Bhadranavar, and Sanjay Kulkarni Pankaj JoshiPankaj Joshi More articles by this author , Cora FoggingCora Fogging More articles by this author , Daniel GomezDaniel Gomez More articles by this author , Apurva AnandApurva Anand More articles by this author , Rateesh RajendranRateesh Rajendran More articles by this author , Shreyas BhadranavarShreyas Bhadranavar More articles by this author , and Sanjay KulkarniSanjay Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Redo Urethroplasty after pelvic fracture urethra injury are challenging cases. Bulbar necrosis happens due to poor flow in the circumflex and dorsal penile arteries. These leads to long gaps. We have extensive experience of bulbar urethral necrosis .Our algorithm uses pedicled preputial tube as the best option for such condition. We present rare situations where there are desperate attempts to solve the remaining gaps .and it works, How? METHODS: Our tertiary referral centre caters to over 500 Urethroplasties a year. These include more than 120 PFUI. We collected prospective data from 2010.These is a worksheet with over 50 parameters .Patients with bulbar necrosis with pedicled tube and yet remaining gap were included. We excise the outer skin as onlay one side(inner or outer) can be used as a flap. If there is still a gap remaining between the 2 urethral ends, we have used the excised preputial skin as free tube. We wrapped the dartos of the pedicled tube around the free tube. And it works. Catheter was kept for 6 weeks.Pericatheter urethrogram was performed before catheter removal. Patients were followed long term with uroflow, PVR,USG for upper tracts and AUA symptom score RESULTS: We had 9 patients out of 1564 who had such situations as shown in the video. In all 9 patients the urethra remained patent .Patients had good voiding per urethra. All patients had ED and 3. underwent penile prosthesis. All patients had post micturition dribble and diverticulum formation in long term. CONCLUSIONS: It is not recommended to perform free graft tube. However there are desperate situations. In these cases the blood supply came from the wrapped dartos tissue around the free graft tube. Other options would have been to leave a penoscrotal urethrostomy at the distal end of tube and perform a second staged penile urethroplasty later.Desperation urethroplasty works. Complex situations need simple answers. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e750 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pankaj Joshi More articles by this author Cora Fogging More articles by this author Daniel Gomez More articles by this author Apurva Anand More articles by this author Rateesh Rajendran More articles by this author Shreyas Bhadranavar More articles by this author Sanjay Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...

Value of transrectal color Doppler ultrasound of the common penile arteries in the diagnosis of arteriogenic erectile dysfunction: A pilot study.

Penile duplex Doppler ultrasound in combination with intra-cavernous injection of vasoactive agents (PDDU-ICI) is the most accepted tool for diagnosis of arteriogenic erectile dysfunction (AED), but is invasive, time consuming and at risk of side effects. The purpose of this pilot study is to evaluate the potential of transrectal color Doppler ultrasound (TR-CDU) of the common penile arteries as a non-invasive method for the diagnosis of AED. A consecutive series of 61 men consulting for erectile dysfunction (ED) and 20 controls underwent TR-CDU examination, aged from 40 to 80 years. Sonographic parameters were correlated with the International Index of Erectile Function, short form (IIEF-5). Sensitivity and specificity were calculated and the areas under the receiver operating characteristic curves (AUC) were compared to evaluate the diagnostic performance. Receiver operating characteristic curve analysis showed no significant results for IIEF-5 score ⩾21 in relation to the Doppler parameters. However, we found a good diagnostic performance for patients with ED grading from moderate to severe at IIEF-5. In this cohort, we found that mean peak systolic velocity >15.8 cm/s predicted IIEF-5 ⩾17 (AUC = 0.73, p = 0.002) with 61.5% sensitivity and 85.7% specificity. Mean end diastolic velocity >1.46 cm/s predicted IIEF-5 ⩾17 (AUC = 0.68, p = 0.02) with 80.7% sensitivity and 52.4% specificity. Mean resistance index ⩽0.72 predicted IIEF-5 ⩾17 (AUC = 0.71, p = 0.004) with 46.2% sensitivity and 95.2% specificity. Mean pulsatility index ⩽1.41 predicted IIEF-5 ⩾17 (AUC = 0.75, p = 0.0005) with 48.5% sensitivity and 95.14% specificity. TR-CDU proved to be a feasible and non-invasive procedure, easily repeatable and not time consuming, overcoming the limits of PDDU-ICI. Diagnostic accuracy seems to be promising in discriminating patients with normal erectile function or mild dysfunction from those with moderate to severe ED. However, these findings need to be verified in future controlled randomized clinical trials.