Venogenic Erectile Dysfunction Research Articles

IMPROVING THE ACCURACY OF VASCULAR TESTING IN IMPOTENT MEN: CORRECTING HEMODYNAMIC ALTERATIONS USING A VASOACTIVE MEDICATION RE-DOSING SCHEDULE

Arteriogenic or venogenic vascular insufficiency is the most common pathophysiology of organic erectile dysfunction. While vascular insufficiency may be suspected on history and physical examination, the definitive diagnosis is made by vascular testing. Dynamic infusion cavernosometry is a recognized technique for evaluating the hemodynamics of erection. Assigning the correct vascular diagnosis during testing is important. Complete corporeal smooth muscle relaxation is essential for obtaining accurate data. Previously others have suggested that repeat dosing with vasoactive medication may improve the diagnostic accuracy of vascular testing. We investigated the hemodynamic effect of repeat doses of medication. Data were prospectively obtained on men undergoing dynamic infusion cavernosometry. When veno-occlusive parameters were abnormal, the intracavernous vasoactive agent dose was repeated to a maximum of 3 doses. Standard dynamic infusion cavernosometry criteria were used for diagnosing arteriogenic and venogenic erectile dysfunction. We analyzed the proportion of men in whom the vascular diagnosis was altered using this regimen. Of 420 men undergoing dynamic infusion cavernosometry, 70% warranted re-dosing based on abnormal veno-occlusive parameters. Of these 294 men veno-occlusive values were corrected by repeat medication in 32% and, therefore, they would have been falsely diagnosed with venous leakage during vascular evaluation. Half of all corrections occurred with the second dose, while half of the patients required a third dose of medication. These data should encourage clinicians to consider re-dosing during the vascular evaluation of men in whom incomplete corporeal smooth muscle relaxation is suspected. In this way a false diagnosis of venous leakage may be avoided in a significant number of cases.

Pelvic venoablation with ethanol for the treatment of erectile dysfunction due to veno-occlusive dysfunction

Objectives. To perform pelvic venoablation with ethanol injection into the deep dorsal vein for the treatment of 10 patients with venogenic erectile dysfunction. This procedure was easily performed without any selective embolization technique. The efficacy and safety of this technique are discussed. Methods. A total of 10 patients with veno-occlusive dysfunction, severe enough to make vaginal insertion impossible, underwent pelvic venoablation with ethanol. The mean patient age was 67.1 years. Under spinal anesthesia, after the venous leaks were identified by cavernosography, a 20-gauge flexible needle was inserted into the deep dorsal vein. The pelvic venogram obtained with deep dorsal venography was included in what was revealed by the venogram obtained with cavernosography. A mixture of absolute ethanol and contrast medium (4:1) was used as a sclerosing agent. Under fluoroscopic control, the sclerosing agents were injected into the deep dorsal vein through a flexible needle. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Results. The follow-up ranged from 25 to 37 months (mean 32.3). At the short-term follow-up visit (less than 6 months), 7 patients (70%) reported erections sufficient for vaginal insertion; at the long-term follow-up visit, 5 men (50%) reported sustained, sufficient potency and 5 (50%) reported persistent erectile dysfunction. No serious complications occurred. Conclusions. Our pelvic venoablation technique using ethanol was effective, minimally invasive, and cost-effective.

O-8-4 - Antiulcer properties of some prolin-containing oligopeptides

To determine the etiology of cases with organic erectile dysfunction (ED), invasive techniques are needed that can induce patient anxiety and disturb test results.To find any special patterns of nocturnal penile tumescence and rigidity (NPTR) records in cases of vasculogenic impotence that can differentiate cases of arterial and venous origin without resorting to the more invasive diagnostic tests.This study included 95 cases of ED (77 cases with abnormal NPTR records plus 18 cases with normal NPTR). History taking and clinical examination with estimation of serum androgen hormones and postprandial blood glucose were done. All patients were then subjected to the following: NPTR monitoring using RigiScan device (Dacomed Corporation, Minneapolis, MN, USA), pharmacopenile duplex ultrasound examination, and redosing pharmacocavernosometry. According to the results of these tests, patients were classified into four groups: psychogenic, arteriogenic, venogenic, and combined arteriogenic–venogenic ED groups. Receiver operator characteristic (ROC) curve analysis of the different RigiScan parameters of venogenic group vs. the arteriogenic group was done. Best parameters were then retested by using them in prediction of veno‐occlusive dysfunction (VOD) in all studied patients.Different RigiScan parameters: number of events, duration of best episode, base tumescence, base rigidity, tip tumescence, and tip rigidity.RigiScan parameters were statistically lower in venogenic than in arteriogenic group and were more correlated with flow to maintain than the peak systolic velocity. ROC curve analysis showed that VOD can be predicted if the duration of the best event is <11.5 minutes (diagnostic accuracy 83.7%) or tip rigidity is <36.5% (diagnostic accuracy 81.6%). On generalizing these values in all patients, duration of best event showed diagnostic accuracy of 88.4%.VOD can be predicted if duration of the best event of NPTR monitoring is less than 11.5 minutes, but the presence of concomitant arterial dysfunction cannot be excluded. Elhanbly S and Elkholy A. Nocturnal penile erections: The role of RigiScan in the diagnosis of vascular erectile dysfunction. J Sex Med 2012;9:3219–3226.

O-8-2 - Therapeutic effect of yohimbine in organic and non-organic erectile dysfunction

To determine the etiology of cases with organic erectile dysfunction (ED), invasive techniques are needed that can induce patient anxiety and disturb test results.To find any special patterns of nocturnal penile tumescence and rigidity (NPTR) records in cases of vasculogenic impotence that can differentiate cases of arterial and venous origin without resorting to the more invasive diagnostic tests.This study included 95 cases of ED (77 cases with abnormal NPTR records plus 18 cases with normal NPTR). History taking and clinical examination with estimation of serum androgen hormones and postprandial blood glucose were done. All patients were then subjected to the following: NPTR monitoring using RigiScan device (Dacomed Corporation, Minneapolis, MN, USA), pharmacopenile duplex ultrasound examination, and redosing pharmacocavernosometry. According to the results of these tests, patients were classified into four groups: psychogenic, arteriogenic, venogenic, and combined arteriogenic–venogenic ED groups. Receiver operator characteristic (ROC) curve analysis of the different RigiScan parameters of venogenic group vs. the arteriogenic group was done. Best parameters were then retested by using them in prediction of veno‐occlusive dysfunction (VOD) in all studied patients.Different RigiScan parameters: number of events, duration of best episode, base tumescence, base rigidity, tip tumescence, and tip rigidity.RigiScan parameters were statistically lower in venogenic than in arteriogenic group and were more correlated with flow to maintain than the peak systolic velocity. ROC curve analysis showed that VOD can be predicted if the duration of the best event is <11.5 minutes (diagnostic accuracy 83.7%) or tip rigidity is <36.5% (diagnostic accuracy 81.6%). On generalizing these values in all patients, duration of best event showed diagnostic accuracy of 88.4%.VOD can be predicted if duration of the best event of NPTR monitoring is less than 11.5 minutes, but the presence of concomitant arterial dysfunction cannot be excluded. Elhanbly S and Elkholy A. Nocturnal penile erections: The role of RigiScan in the diagnosis of vascular erectile dysfunction. J Sex Med 2012;9:3219–3226.

Electrical activity of the corpus cavernosum in patients with corporal veno-occlusive dysfunction.

To determine whether the pattern of discoordination (an increase in electrical activity of the corpus cavernosum after an intracavernous injection with papaverine and which results in the contraction of the cavernous smooth muscles instead of relaxation) is an aetiological factor in veno-occlusive dysfunction (VOD). Electromyography of the corpus cavernosum was performed before and after an intracavernous injection with 60 mg papaverine in 45 patients diagnosed as having venogenic erectile dysfunction by colour Doppler ultrasonic flowmetry and dynamic infusion cavernosometry and cavernosography. Cavernosometric values were compared in patients with and with no pattern of discoordination. A pattern of discoordination occurred in 14 patients (31%). There were significant differences in the cavernosometric values of patients with and with no discoordination. A poor response to papaverine and greater venous leakage were observed in the patients showing discoordination. The pattern of discoordination diagnosed by electromyography after injection with papaverine may explain some aspects of VOD and highlights the importance of performing electromyography of the corpus cavernosum in the diagnostic evaluation of VOD.

Prognostic Factors for the Postoperative Outcome of Penile Venous Surgery for Venogenic Erectile Dysfunction

Since penile venous surgery is usually associated with a poor postoperative outcome, a study was done to evaluate possible prognostic factors for this procedure. A total of 77 patients with erectile dysfunction underwent ligation of all dorsal penile veins and resection of the deep dorsal penile vein for venous incompetence. In all patients a comprehensive evaluation was done preoperatively. All patients did not respond to pharmacotherapy and had a venous leak. After a followup of 6 months, patients were classified as having full spontaneous erections, failure and response to pharmacotherapy. Of the 77 patients 31 (40.3%) had full spontaneous erections, 8 (10.3%) were currently responding to pharmacotherapy and 38 (49.4%) failed. The maintenance flow was 75 ± 45ml. per minute in the group with spontaneous erections and 103 ± 60ml. per minute in the failure group (p = 0.20). Mean patient age was 49.8 ± 11.7 and 49.1 ± 10.2 years, respectively (p = 0.23). Of the 41 patients with normal single potential analysis of cavernous electrical activity 28 had full erections postoperatively, 5 responded to pharmacotherapy and 8 failed, compared to 3, 3 and 30, respectively, of the 36 patients with abnormal single potential analysis of cavernous electrical activity. After a mean followup of 21 months (range 6 to 47 months), 4 patients with full erections at 6 months postoperatively currently require intracavernous pharmacotherapy. Our results indicate that single potential analysis of cavernous electrical activity seems to be an important prognostic factor for the postoperative outcome of penile venous surgery for venogenic impotence.

Pulmonary Migration of Coils Inserted for Treatment of Erectile Dysfunction Caused by Venous Leakage

Embolization of penile veins by coils and/or detachable balloons has been reported as a possible effective form of treatment of venogenic erectile dysfunction. The major appeal for this avenue of therapy in these patients is the reported low morbidity and negligible rate of complications compared to an open operation. We describe a case of asymptomatic pulmonary migration of a coil placed for venous leakage in a patient in whom the procedure was conducted through the femoral vein rather than the deep dorsal vein. We conclude that patients undergoing coil embolization for venous leakage should be appraised of the potential for coil migration.