OBJECTIVESTo evaluate the clinic value of doppler ultrasonography in diagnosis of vasculogenic erectile dysfunction (ED).

METHODSThe hemodynamic change was obsreved by doppler ultrasonography during the erection of penis and the results between patients with vasculogenic ED and controls were compared. The doppler ultrasonographic characteristics of vascular ED was analyzed.

RESULTSIn the patients with arterial ED the peak systolic velocity(PSV) in deep artery was apparently lower than controls(P < 0.01), and in the patients with venous ED, the velocity of deep dorsal vein was higher during complete erection than controls(P < 0.05).

CONCLUSIONSThe result of doppler ultrasonography examination effectively helps the diagnosis of vasculogenic.

Adult ; Humans ; Impotence, Vasculogenic ; diagnostic imaging ; Male ; Penis ; blood supply ; Regional Blood Flow ; Ultrasonography, Doppler, Color

OBJECTIVETo evaluate the diagnosis and treatment of high-flow priapism (HFP).

METHODSFour cases of HFP following blunt trauma to the penis or perinea underwent diagnostic examination by colour-flow Doppler ultrasound and/or superselective pudendal arteriography, which revealed bilateral arteriocorporal fistula in 1 case and monolateral in the other 3. Penile detumescence was obtained in 2 cases by superselective bilateral/monolateral arteriographic embolization of the pudendal artery with absorbable gelatin

RESULTSThe former 2 cases effected an immediate recovery of the sponge, while the other 2 cases received conservative treatment. Erectile function, able to perform normal sexual intercourse in approximately 2 months. But in the latter 2, follow-up revealed unsatisfactory potency.

CONCLUSIONSuperselective arteriographic embolization with absorbable gelatin sponge can provide a safe, selective and effective treatment for HFP patients.

Adult ; Angiography ; Arteries ; Embolization, Therapeutic ; Humans ; Male ; Penis ; blood supply ; Priapism ; diagnostic imaging ; therapy

Penile amputation and successful replantation is very uncommon, and there is no routine standardized procedures for dealing with this medical condition. Here we report two cases of penile amputation and replantation involving different degrees of vascular insult leading to different pathogenesis, clinical presentation, surgical approach and prognosis. This report described the microsurgical procedure and postoperative care using bipedicled scrotal flap to achieve successful engraftment and function. A review of the published data and future methods to increase success of such surgical procedures is provided.
Adult ; Amputation, Traumatic ; surgery ; Humans ; Male ; Microsurgery ; Penis ; blood supply ; injuries ; surgery ; Replantation ; methods

OBJECTIVESTo evaluate the curative effect of embedding deep dorsal vein of penis on erectile dysfunction (ED).

METHODSThree patients with venous ED and 2 patients with mixed factors of artery and vein were treated by the embedding deep dorsal vein of penis. For evaluating curative effect the 5 patients were visited after operation.

RESULTSTwo months after surgery, the 3 patients of venous ED achieved satisfactory intercourse and the 2 patients with mixed factors of artery and vein had sufficient erection for intercourse after taking 50 mg Sildenafil. The 5 cases kept the above-mentioned curative effect during the follow up period between 3 to 12 months (7 months on avenage).

CONCLUSIONSThe embedding deep dorsal vein surgery, having small surgical wounds and few complications, is an effective treatment for venous ED.

Adult ; Humans ; Impotence, Vasculogenic ; surgery ; Male ; Penis ; blood supply ; surgery ; Veins ; surgery

OBJECTIVETo investigate the run and distribution of penile deep veins and to evaluate the application of the findings to penile vein ligating operation.

METHODSWe dissected the penises of 28 formalin-preserved male adult cadavers, whose health condition, penile erection condition when alive, exact age and cause of death were unknown, and recorded the number and location of the cavernous and crural veins and their relationship with the surrounding important organs and tissues.

RESULTSThe cavernous veins emerged from the dorsal groove of the fixed segment, ran proximately in the dorsal groove, branched into two and drained into either side of the internal pudendal vein respectively, with the internal pudendal artery-cavernous artery-dorsal artery system running laterally and superficially. All the cavernous veins had communications with the periprostatic venous plexus. In the 56 crura of the 28 specimens, there were 250 crural veins, 76 in 42 sides (75.0%) traveling medial to the internal pudendal artery-cavernous artery-dorsal artery system.

CONCLUSIONThe penile deep venous system is structurally complicated, extensively connected with the surrounding veins and closely related to the surrounding organs, which makes it very difficult to ligate all the deep veins and avoid damage to the cavernous arteries and nerves in vein-involved surgery.

Adult ; Humans ; Male ; Penile Erection ; Penis ; anatomy & histology ; blood supply ; Veins ; anatomy & histology

OBJECTIVESTo investigate the correlation between corpus cavernosum disruption and high-flow priapism for the understanding of high-flow priapism and its treatment.

METHODSTo report the clinical data of a case of spontaneous idiopathic high-flow priapism.

RESULTSThe diagnosis was made as right cavernosal artery disruption after angiography. The result of cavernosal blood gas analysis was normal. The penis became detumescent after the gelatin embolization treatment was performed.

CONCLUSIONSSpontaneous high-flow priapism of old people(non-ischemic) is rare in clinic. Blood gas analysis and angiography are needed to find the hemorrhage site when conservative treatment fails. Gelatin embolization or cavernosal artery ligation are usually effective in the subsequent treatment.

Angiography ; Blood Gas Analysis ; Embolization, Therapeutic ; Humans ; Male ; Middle Aged ; Penis ; blood supply ; Priapism ; diagnosis ; therapy ; Regional Blood Flow

Animal models for the study of erectile function monitoring the changes in intracavernous pressure (ICP) during penile erection was reviewed. The development of new models using small commercially-available experimental animals, rats and mice, in the last decade facilitated in vivo investigation of erectile physiology. The technique enabled to evaluate even subtle erectile responses by analyzing ICP and systemic blood pressure. Moreover, the method has been well improved and studies using conscious animal models without the influence of any drug or anesthesia are more appropriate in exploring the precise physiological and pharmacological mechanisms in erection. Also, more natural and physiological sexual arousal instead of electrical or pharmacological stimulation is desirable in most of the studies. This article reviewed the development of ICP studies in rats and mice.
Animals ; Disease Models, Animal ; Erectile Dysfunction ; physiopathology ; Male ; Penile Erection ; physiology ; Penis ; blood supply ; physiopathology ; Regional Blood Flow ; physiology

The clinical reports on Sildenafil sulfate (Viagra) are mainly based on individual observations. However, there is a paucity of objective studies in the literature. In order to objectively examine the effect of Sildenafil, a SS (Sexual Stimulation)- Penogram that is a non-invasive, simple and physiologic method was developed using a radioisotope (RI). One hundred and four SS-penograms were performed on patients who had a documented erectile dysfunction (ED) lasting for more than 6 months. After an intravenous injection of 99mTc-RBC (15 mCi), the first penogram was taken immediately after sexual stimulation, which was done by 30 minutes of erotic videotape viewing. Forty minutes after administering 25 to 100 mg of Sildenafil, a second penogram was taken. The characteristics of each penogram were analyzed according to a previously reported method. The results were graded as follows; Type I(normal function; 5 min or more of peak erectile response with an induction period of 1 to 6 min), Type II-A (impossible function type; i.e., showing less than 2 times the basal radioactivity level), Type II-B (the unstable type; showing less than 5 min of peak erectile response), and Type II-C (the delayed type; which showed a delay of more than 15 min after the start of sexual stimulation). The patients were grouped according to their response after Sildenafil administration, and the effect of Sildenafil was assessed by comparing the radioactivity from between 7 to 22 minutes and the changes in the characteristics of the penogram. The mean age of the patients was 44.9 +/- 10.2 (23 - 68) years. In the first penogram, Type I was found in 12 patients, and Type II-A in 14, Type II-B in73, Type II-C in 1 and a mixed (II-B + C) type was found in 4 patients. A second penogram after Sildenafil administration, showed Type I in 46 patients, and Type II-A in 10, Type II-B in 46 and a mixed type was found in 2 patients. The responses after Sildenafil were categorized as follows: 1) An excellent response group (consisting of 56 patients-53.9%); Those who showed greater than 50% increase in the RI area after Sildenafil treatment. 2) A good response group consisting of (23 patients-22.1%); i.e., those who showed a less than 50% but greater than a 20% increase in the RI area after Sildenafil administration. 3) A borderline group (consisting of 15 patients-14.4%); showing less than a 20% change in the RI area after Sildenafil treatment. 4) non-response group (consisting of 10 patients-9.6%). The therapeutic efficacy of Sildenafil, as determined by the SS-penograms, revealed that there was an augmentation in the erectile capabilities in 76% of men (79/104) but a non-response was observed in 9.6% (10/104). The efficacy of Sildenafil on the SS-penogram did not correlate with the patient's age (p=0.198). It is believed that the SS-penogram can be used to accurately evaluate the natural erectile status in sexual and pharmacological stimulation, and provides the most objective erectile response in any therapeutic trial. Consequently, the primary challenge for any erectile dysfunction remedy is to be able to demonstrate its efficacy. A further evaluation is warranted in the non-response group, which was not based on any severe organic dysfunction.
Adult ; Age Factors ; Aged ; Human ; Impotence/*diagnosis ; Male ; Middle Age ; Penis/*blood supply ; Piperazines/pharmacology ; Technetium/*diagnostic use

OBJECTIVETo study the five-year postoperative effect of the ligation and resection of the deep penile vein for the patient of erectile dysfunction (ED) caused by penile venous leakage.

METHODSSixteen ED patients received deep penile vein ligation and resection. Observations of the penile erection had been recorded for 5 years after surgery.

RESULTSEight cases demonstrated erectile hypofunction after 18 months postoperatively and total ED after 21-30 months of which 6 were improved by chemotherapy, and 2 showed no improvement. Seven cases remained normal and 1 case get out of touch at the 24th month postoperatively.

CONCLUSIONSThe ligation and resection of the deep penile vein can be considered as an easy and effective method to treat patients of ED caused by penile venous leakage.

Adult ; Follow-Up Studies ; Humans ; Impotence, Vasculogenic ; surgery ; Ligation ; Male ; Middle Aged ; Penis ; blood supply ; Postoperative Complications ; Veins ; surgery

Priapism is defined as abnormal prolonged penile erection occurring beyond or unrelated to sexual interest. The disorder is enigmatic yet devastating because of its elusive etiology, irreversible erectile tissue damage, and resultant erectile dysfunction (ED). Current management strategies suffer from a poor understanding of the pathophysiology, especially at the molecular level. The traditional treatments are based more on empirical rather than evidence-based knowledge. The outcomes for restoration of normal erectile function are poor, especially for stuttering priapism. Therefore, it is critical to understand priapism from a molecular level, to formulate treatment strategies and to establish rational prevention strategies for high-risk populations, such as sickle cell disease (SCD) patients and cases of the stuttering variant. This review focuses on the recent advances at the molecular level in priapism and penile erection, and applies the recent knowledge to the treatment of stuttering priapism.
Hormones ; therapeutic use ; Humans ; Ischemia ; complications ; Male ; Penile Prosthesis ; Penis ; blood supply ; Priapism ; drug therapy ; etiology ; surgery ; Recurrence