Penile Revascularization Surgery in Erectile Dysfunction

Hauri, D.

doi:10.1159/000068187

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…This procedure is comprised mainly of direct arterial anastomosis of IEA to DPA, and incorporation of DDV into the anastomosis (Fig. ) . In that the principles of penile revascularization encompass proximal or distal ligation of the arterialized vein, ligation of the circumflex vessels, destruction of the valves in the dorsal vein, as well as shunts between artery and vein, many other variations have been proposed …”

Section: Penile Revascularization Surgerymentioning

confidence: 99%

Surgical niche for the treatment of erectile dysfunction

Hsieh

Hsu²,

Chang

et al. 2019

Int J of Urology

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Penile erection implicates arterial inflow, sinusoidal relaxation and corporoveno‐occlusive function. By far the most widely recognized vascular etiologies responsible for organic erectile dysfunction can be divided into arterial insufficiency, corporoveno‐occlusive dysfunction or mixed type, with corporoveno‐occlusive dysfunction representing the most common finding. In arteriogenic erectile dysfunction, corpora cavernosa show lower oxygen tension, leading to a diminished volume of cavernosal smooth muscle and consequential corporoveno‐occlusive dysfunction. Current studies support the contention that corporoveno‐occlusive dysfunction is an effect rather than the cause of erectile dysfunction. Surgical interventions have consisted primarily of penile revascularization surgery for arterial insufficiency and penile venous surgery for corporoveno‐occlusive dysfunction, whatever the mechanism. However, the surgical effectiveness remained debatable and unproven, mostly owing to the lack of consistent hemodynamic assessment, standardized select patient and validated outcome measures, as well as various surgical procedures. Penile vascular surgery has been disclaimed to be the treatment of choice based on the currently available guidelines. However, reports on penile revascularization surgery support its utility in treating arterial insufficiency in otherwise healthy patients aged <55 years with erectile dysfunction of late attributable to arterial occlusive disease. Furthermore, it is noteworthy that penile venous surgery might be beneficial for selected patients with corporoveno‐occlusive dysfunction, especially with a better understanding of the innovated venous anatomy of the penis. Penile vascular surgery might remain a viable alternative for the treatment of erectile dysfunction, and could have found its niche in the possibility of obtaining spontaneous, unaided and natural erection.

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Section: Penile Revascularization Surgerymentioning

confidence: 99%

Surgical niche for the treatment of erectile dysfunction

Hsieh

Hsu²,

Chang

et al. 2019

Int J of Urology

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“…Unsuccessful performance of this type of anesthesia might cause sensoric disturbances and complicate the future sexual life of the patient [50,51]. During the revascularization surgery of erectile dysfunction, the surgeon also operates in the region where nervus dorsalis penis is running close to pubis and can thus damage the nerve [52]. During radical prostatic or urinary bladder surgery, the neurovascular supply can also be directly or indirectly damaged and immediate or delayed clinically significant erectile dysfunction might develop [53].…”

Section: Clinical Considerations Of Nervus Dorsalis Penis/clitoridismentioning

confidence: 99%

Clinical Implications of a Close Vicinity of Nervus Dorsalis Penis/Clitoridis and Os Pubis

Šedý

Naňka

Špačková

et al. 2008

The Journal of Sexual Medicine

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Introduction Close relation of nervus dorsalis penis/clitoris and os pubis has a major impact in surgical disciplines. Aim To summarize a current knowledge about this region, represented by the course of sulcus nervi dorsalis penis/clitoridis. Methods Literature search of years 1970–2007. Main Outcome Measures In male, it accommodates nervus dorsalis penis whereas in female nervus et arteria dorsalis clitoridis. Lateral border of sulcus nervi dorsalis penis corresponds to vertical ridge and lateral border of sulcus nervi dorsalis clitoridis to ventral arc—two parameters, which are parts of the Phenice's method for sexing of isolated os pubis. Results Exact preparation of nervus dorsalis penis is crucial in correct performance of conversion of genitalia in patients with transsexualism, in reconstruction of posterior urethra, in hypospadia, during performance of penile blockade during circumcision and in revascularization surgery of erectile dysfunction. Possible role of the sulcus nervi dorsalis penis in the Alcock's syndrome is discussed. Similarly, it is advisable to take care of nervus dorsalis clitoridis during reduction clitoridoplasty in patients with adrenogenital syndrome and during the insertion of transobturator vaginal tape. Injury of nervus dorsalis penis/clitoridis leads to hypestesia or anestesia of glans penis/clitoridis. The injury to arteria dorsalis clitoridis leads to bleeding and/or hematoma. Conclusions Clinical anatomy of sulci is important in several situations in urologic surgery. It is possible to use sulcus nervi dorsalis penis/clitoridis for sexing of isolated pubis for antropological or forensic purposes.

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“…Das Gemeinsame an der Vielzahl der seit den ersten publizierten Verfahren ist, dass die A. epigastrica inferior als Donorgefäß Verwendung findet. Im deutschsprachigen Raum hat v. a. die von Hauri 1983 propagierte Dreifachanastomose in den 1980er Jahren Verbreitung gefunden [9,12,19,21,29].…”

Section: Penile Revaskularisationschirurgieunclassified

“…Beide Methoden werden als experimentell klassifiziert. Das hat v. a. seine Gründe in den uneinheitlichen Selektionskriterien,in den fehlenden kontrollierten Studien und in den z.T.widersprüchlichen Indikationsstellungen.Lediglich eine hochselektive Gruppe von ED-Patienten (<50 Jahre mit isolierter arteriogen bedingter ED oder kongenitaler Aplasie der Penisarterien) dürfte nach heutigem Wissensstand von einer penilen Revaskularisationsoperation profitieren [12,29].Weitere Kriterien für eine erfolgreiche Revaskularisation sind eine adäquate Technik und eine frühe Operationsindikation, bevor es zu einer Fibrose der glatten Schwellkörpermuskulatur oder zu einer neuronalen Degeneration peniler Nervenfasern kommt [9].…”

Section: Schlussfolgerungunclassified

Operative Therapie der erektilen Dysfunktion

2003

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In the light of the current domination of oral pharmacotherapy for the treatment of erectile dysfunction, the aim of this paper is to give a critical and up-to-date overview of the possibilities of surgical therapy. We evaluate possible therapy options such as penile vein surgery, arterial revascularisation surgery and penile prosthetics surgery. Today, vein surgery has faded into total insignificance due to the efficiency of oral and intracavernous therapeutics, and as a result of the pathomechanism of cavernoveinous insufficiency and the disappointing long-term results published in the literature. A similar fate has been met by penile revascularisation surgery, which today is performed only in a very limited number patients with strict selection criteria such as age and exclusion of diabetes mellitus. Thus, aside from pharmacotherapy, penile prosthetics is the only surgical therapy option maintaining its significance as a cure for erectile dysfunction. There are convincing long-term results with a high degree of patient and partner satisfaction, high patient acceptance and a good functional durability of the mostly three-part hydraulic implants.

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Penile Revascularization Surgery in Erectile Dysfunction

Cited by 10 publications

References 19 publications

Surgical niche for the treatment of erectile dysfunction

Surgical niche for the treatment of erectile dysfunction

Clinical Implications of a Close Vicinity of Nervus Dorsalis Penis/Clitoridis and Os Pubis

Operative Therapie der erektilen Dysfunktion

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