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Penile vascular surgery for treating erectile dysfunction: Current role and future direction.

Molodysky E, Liu SP, Huang SJ, Hsu GL - Arab J Urol (2013)

Bottom Line: Pascal's law has been shown to be a significant, if not the major, factor in erectile mechanics, with recent haemodynamic studies on fresh and defrosted human cadavers showing rigid erections despite the lack of endothelial activity.Penile venous stripping surgery has been shown to be beneficial in correcting veno-occlusive dysfunction, with outstanding results.Penile vascular reconstructive surgery is viable if, and only if, the surgical handling is appropriate using a sound method.

View Article: PubMed Central - PubMed

Affiliation: Discipline of General Practice, Sydney Medical School, University of Sydney, Australia.

ABSTRACT
Penile vascular surgery for treating erectile dysfunction (ED) is still regarded cautiously. Thus we reviewed relevant publications from the last decade, summarising evidence-based reports consistent with the pessimistic consensus and, by contrast, the optimistically viable options for vascular reconstruction for ED published after 2003. Recent studies support a revised model of the tunica albuginea of the corpora cavernosa as a bi-layered structure with a 360° complete inner circular layer and a 300° incomplete outer longitudinal coat. Additional studies show a more sophisticated venous drainage system than previously understood, and most significantly, that the emissary veins can be easily occluded by the shearing action elicited by the inner and outer layers of the tunica albuginea. Pascal's law has been shown to be a significant, if not the major, factor in erectile mechanics, with recent haemodynamic studies on fresh and defrosted human cadavers showing rigid erections despite the lack of endothelial activity. Reports on revascularisation surgery support its utility in treating arterial trauma in young males, and with localised arterial occlusive disease in the older man. Penile venous stripping surgery has been shown to be beneficial in correcting veno-occlusive dysfunction, with outstanding results. The traditional complications of irreversible penile numbness and deformity have been virtually eliminated, with the venous ligation technique superseding venous cautery. Penile vascular reconstructive surgery is viable if, and only if, the surgical handling is appropriate using a sound method. It should be a promising option in the near future.

No MeSH data available.


Related in: MedlinePlus

An illustration of the Furlow–Fisher procedure. The inferior vein is fashioned to the DDV, which is ligated distally, proximally and at lateral locations of the circumflex veins.
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f0020: An illustration of the Furlow–Fisher procedure. The inferior vein is fashioned to the DDV, which is ligated distally, proximally and at lateral locations of the circumflex veins.

Mentions: In 1973, Michal et al. [17] reported the first study of penile arterial reconstruction in an attempt to enhance arterial flow to the CC. They devised PRS using the anastomosis of the inferior epigastric artery (IEGA) to the CC. Subsequently, DDV arterialisations, either with no extensive venous ligation or with venous ligation, were introduced by Virag [18] and Haudi [19] in 1981 and 1986, respectively. In an effort to deliver better outcomes, various modifications were used, such as the Furlow–Fisher procedure (Fig. 4), in which IEGA was made in an end-to-side anastomosis to the DDV, while several ligations were made at the lateral circumflex veins, in proximal and distal locations [20]. The outcomes of arterial PRS are varied due to many causes, e.g., patient selection, surgical instruments and surgical technique. In general, its merit is limited, with no long-term benefits (Table 1). Significant complications appear to be unavoidable, i.e., the risk of postoperative penile shortening and decreased penile sensation. Not surprisingly, it has been regarded as experimental among most surgeons [21].


Penile vascular surgery for treating erectile dysfunction: Current role and future direction.

Molodysky E, Liu SP, Huang SJ, Hsu GL - Arab J Urol (2013)

An illustration of the Furlow–Fisher procedure. The inferior vein is fashioned to the DDV, which is ligated distally, proximally and at lateral locations of the circumflex veins.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442997&req=5

f0020: An illustration of the Furlow–Fisher procedure. The inferior vein is fashioned to the DDV, which is ligated distally, proximally and at lateral locations of the circumflex veins.
Mentions: In 1973, Michal et al. [17] reported the first study of penile arterial reconstruction in an attempt to enhance arterial flow to the CC. They devised PRS using the anastomosis of the inferior epigastric artery (IEGA) to the CC. Subsequently, DDV arterialisations, either with no extensive venous ligation or with venous ligation, were introduced by Virag [18] and Haudi [19] in 1981 and 1986, respectively. In an effort to deliver better outcomes, various modifications were used, such as the Furlow–Fisher procedure (Fig. 4), in which IEGA was made in an end-to-side anastomosis to the DDV, while several ligations were made at the lateral circumflex veins, in proximal and distal locations [20]. The outcomes of arterial PRS are varied due to many causes, e.g., patient selection, surgical instruments and surgical technique. In general, its merit is limited, with no long-term benefits (Table 1). Significant complications appear to be unavoidable, i.e., the risk of postoperative penile shortening and decreased penile sensation. Not surprisingly, it has been regarded as experimental among most surgeons [21].

Bottom Line: Pascal's law has been shown to be a significant, if not the major, factor in erectile mechanics, with recent haemodynamic studies on fresh and defrosted human cadavers showing rigid erections despite the lack of endothelial activity.Penile venous stripping surgery has been shown to be beneficial in correcting veno-occlusive dysfunction, with outstanding results.Penile vascular reconstructive surgery is viable if, and only if, the surgical handling is appropriate using a sound method.

View Article: PubMed Central - PubMed

Affiliation: Discipline of General Practice, Sydney Medical School, University of Sydney, Australia.

ABSTRACT
Penile vascular surgery for treating erectile dysfunction (ED) is still regarded cautiously. Thus we reviewed relevant publications from the last decade, summarising evidence-based reports consistent with the pessimistic consensus and, by contrast, the optimistically viable options for vascular reconstruction for ED published after 2003. Recent studies support a revised model of the tunica albuginea of the corpora cavernosa as a bi-layered structure with a 360° complete inner circular layer and a 300° incomplete outer longitudinal coat. Additional studies show a more sophisticated venous drainage system than previously understood, and most significantly, that the emissary veins can be easily occluded by the shearing action elicited by the inner and outer layers of the tunica albuginea. Pascal's law has been shown to be a significant, if not the major, factor in erectile mechanics, with recent haemodynamic studies on fresh and defrosted human cadavers showing rigid erections despite the lack of endothelial activity. Reports on revascularisation surgery support its utility in treating arterial trauma in young males, and with localised arterial occlusive disease in the older man. Penile venous stripping surgery has been shown to be beneficial in correcting veno-occlusive dysfunction, with outstanding results. The traditional complications of irreversible penile numbness and deformity have been virtually eliminated, with the venous ligation technique superseding venous cautery. Penile vascular reconstructive surgery is viable if, and only if, the surgical handling is appropriate using a sound method. It should be a promising option in the near future.

No MeSH data available.


Related in: MedlinePlus