Penile vascular surgery for treating erectile dysfunction: Current role and future direction
Journal
Arab Journal of Urology
Journal Volume
11
Journal Issue
3
Pages
254-266
Date Issued
2013
Author(s)
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. ? 2013 Production and hosting by Elsevier B.V. on behalf of Arab Association of Urology.
Subjects
Arterial reconstruction; Erectile dysfunction; Penile arterial insufficiency; Veno-occlusive dysfunction; Venous stripping
SDGs
Other Subjects
lidocaine; phosphodiesterase V inhibitor; acupuncture analgesia; arterial insufficiency; arteriovenous fistula; artery injury; artery reconstruction; cadaver; cavernosography; diabetes mellitus; end to side anastomosis; erectile dysfunction; femoral artery; follow up; hemodynamics; human; hyperlipidemia; hypertension; inferior epigastric artery; infusion rate; internal iliac artery; local anesthesia; longitudinal study; muscle relaxation; nerve fiber; obesity; outcome assessment; pathophysiology; patient selection; penile vascular surgery; penis glans; perineum injury; plastic surgery; postoperative period; preoperative period; review; risk factor; sexual arousal; sexual intercourse; smoking; tunica albuginea; varicosis; vascular surgery; vein ligation; vein stripping
Type
review