No abstract

Intraurethral application of prostaglandin-E1 (MUSEt) is a well-tolerated pharmacotherapy for erectile dysfunction. However, the physiological mechanisms of drug transfer into the cavernous bodies are not completely clear. Using spongiosography in 35 patients, our study tried to elucidate existing shunt mechanisms. The X-rays show venous drainage through the deep dorsal vein up to the plexus Santorini. The circumflex veins are also contrasted and the cavernous bodies show opacification in their distal portion only. Structures shunting directly between the corpus spongiosum and the cavernous bodies were not demonstrable. Retrograde filling of the cavernous bodies through the deep dorsal vein and its circumflex braches seems to be the most relevant way of drug transfer after intraurethral application of prostaglandin-E1. Diffusion into the cavernous bodies or a systemic mechanism of action does not seem probable.

Peyronie's disease is characterized by the formation of a plaque of the tunica albuginea that leads to a mainly dorsally directed penile curvature and penile shortening due to scarification. The exact ethiopathology remains unclear. The natural history of the disease is variable, ranging from spontaneous remissions to chronic, and including severe penile curvature. Therapy should be conservative in the early, painful, progressive phase. No conservative medical or semi-invasive treatment modality, such as extracorporeal shock wave therapy or radiation therapy, is currently available for curing all of the symptoms of this disorder in all patients. All studies with a controlled design showed poor therapeutic outcomes that are frequently identical to the natural course. Surgical therapy should only be performed in the stable stage of the disease. This means that Peyronie's disease should have been present for at least 12 months, and the patient should not have suffered from pain or the progression of symptoms for at least 6 months. The surgical treatment modalities comprise plication procedures (Essed-Schroeder, Nesbit), plaque-incisions with grafting, and the insertion of penile implants with simultaneous correction of the curvature by "penile cracking" or incisions of the plaque.