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April 30, 2016Penile vascular surgery for treating erectile dysfunction (ED) is still regarded cautiously. April 28, 2016Erectile impotence may be due to psychological problems, neurogenic dysfunction, hormonal alterations or compromised penile blood flow. Although, vascular blocks are fairly common in a person with diabetes, blocks to the arteries supplying the penis are rarely the cause of the erectile dysfunction. In fact, even if one considers the full spectrum of erectile dysfunction, irrespective of the somatic cause, only 2% to 3% of all patients meet these criteria for penile arterial bypass. Selective arteriography is recommended only for men who are candidates for arterial revasculization. The objective of the surgery is to increase the blood flow to the corporal body and therefore improve the erections.
Ideally, arterial surgery should be the way to treat erectile dysfunction since it seems logical that a damaged or blocked artery could easily be bypassed to provide the necessary blood needed to maintain an erection. Patients who undergo arteriography should be highly motivated and have a complete workup to rule out all other causes of erectile dysfunction, including hormonal problems or venous leaks. In the ideal procedure, if the common penile artery bifurcation exists, the inferior epigastric artery is connected end-to-end or end-to-side and retrograde flow is achieved into the dorsal artery, If, as in 20% of patients, the sole source of arterial flow to the lacunar spaces is a significant penetrating artery from the dorsal to the cavernosal artery, the procedure is done end-to-side. At many centers, the procedure is effected by taking an artery from a leg and then surgically connecting it to the arteries at the back of the penis, bypassing the blockages and restoring blood flow. The prognosis for the success of reconstructive arterial surgery in reversing ED is 50% to 70%, including conversion to successful injection therapy. In the era of highly effective oral and injectable drug therapy, penile venous surgery must be considered historical. A large number of men suffer from erectile dysfunction as a result of venous leak - a condition that prevents the storage of blood in the penis.
The trapping of blood within the corpora cavernosa by decreasing venous return is a necessary step toward achieving and maintaining erection. The current study of choice for diagnosing veno-occlusive dysfunction is cavernosography and pharmacologic cavernosometry.
For most practical purposes, venous dysfunction can be inferred from the finding of a normal arterial response to intracavernosal injection in the presence of a poor erectile response. Type 1 is due to the presence of an excessively large number of veins exiting the corporal body. Type 2 is the weakening of the tough outer membrane of the corporal membrane of the corporal body known as the tunica albuginea, resulting in poor compression of the veins, such as in elderly men.
Type 3 is the loss of compliance of the cavernosal smooth muscle because of Peyronie's disease or scarring degeneration in patients with severe hardening of the arteries. Type 4 is poor relaxation of the cavernous smooth muscle due to inadequate release of the hormones it takes to create an erection. Type 5 results from abnormal communications between the corpora cavernosa and the spongiosum due to trauma or a prior procedure to treat priapism.

The first choice for patients who have venous leakage is a vacuum erection device or treatment with intercavernosal injections. When it has been determined that the patient is a good candidate for repair, the idea of treatment is to find the vein that is the source of the leakage and then tie it off.
Venous ligation is performed when the penis is unable to store a sufficient amount of blood to maintain an erection. Erectile Dysfunction commonly known as impotence occurs when a man can no longer achieve or maintain an erection firm enough for sexual intercourse.
Although, these may differ from place to place, the general consensus seems to be that Penile arterial revascularization is indicated for only highly selected patients, young men (less than 45 years old) who have penile, perineal, or pelvic trauma and are either not at risk for atherosclerosis or have modifiable risk factors. These are usually young, healthy men who have suffered trauma to the penis or to the area under the scrotum known as the perineum.
The best candidates for surgery are men who have poor erections with spontaneous erections absent and in whom all studies indicate a pure arterial component. Unfortunately, this is not the case because the patients who have this distinct arterial lesion are very limited. Patients should not proceed with arteriography unless they are good candidates for revascularization. In studies of selected patients there was improvement in erectile dysfunction in 50% to 75% of men after five years. In some patients, the only viable recourse for corporal revascularization is arterialization of an isolated segment of the deep dorsal vein.
In arterial revascularization of the penis, (top) the inferior epigastric artery may be connected end-to-side to the dorsal artery or (bottom) an isolated segment of deep dorsal vein may be arterialized. With very few exceptions (cases of ectopic veins in young men), there is no justification for pursuing this kind of treatment in ED patients, especially because most of these procedures end in failure. Veno-occlusive incompetence or dysfunction is defined as the inability to trap blood within the corpora cavernosa to achieve and maintain erection. These procedures are usually carried out at highly specialized centers where the surgeosn have a special interest in researching venous leaks as the cause of erectile dysfunction.
An inability to achieve and maintain the full erection occurs because blood leaks out in the presence of an adequate arterial inflow due to a damaged veno-corporo-occlusive mechanism.
The only patients who are candidates for a venous leakage operation are patients who have failed simple, noninvasive treatments.
If the leaking vessel is near the base of the body, then an incision is made over that area. They include numbness of the penis, scarring, a shortening or twisting of the penis, and painful erections. This operation ties off or removes veins that are causing an excessive amount of blood to drain from the erection chambers. In preparation for vein dissection, the penile shaft is inverted into a standard anterior scrotal incision.

Rafael Moguel’s Clinics of the Heart announces the availability of the new erectile dysfunction vascular procedure that has proven effective in the treatment of this most common condition. We do not sell any prescription drugs and nothing on this site is intended as medical advice. Prior to proceeding with an arteriogram, which is a very invasive procedure, a Duplex Doppler examination showing the presence of poor blood flow and indicating a probable arterial lesion should be performed. Patients with other diseases such as diabetes or heavy smokers are poor candidates for this type of operation.
We feel that good candidates for venous surgery are those who have identified a localized leak and who have had a complete workup to rule out all the obvious causes for erectile dysfunction, including the Duplex Doppler examination. Success rate is estimated at between 40% and 50% initially, but drops to 15% over the long term.
Thus the rare patient is a young man with focal corporal veno-occlusive dysfunction caused by trauma who has normal arterial outflow or who wants a better response to intracavernosal pharmacotherapy.
But if erectile dysfunction is an ongoing problem, it may cause stress, cause relationship problems or affect self-confidence. If an obstruction is visualized, it is important to document whether there is flow back through the blockage to the point of obstruction so that the patient will be sure to benefit from the procedure.
Problems achieving or maintaining an erection is a clear sign of a health condition that requires treatment, such as heart disease or poorly controlled diabetes, atherosclerosis, hypertension. A preoperative X-ray examination called the cavernosogram should identify the site of the leaking vessel.
In the past, venous ligation has also been performed as an adjunct procedure to revascularization. The infrapubic suspensory ligament is dissected (the ligament is approximated with silk ligature at the end of the procedure).
It very frequently coexists with the coronary heart disease, which is responsable for most heart attacks. Costamed Hospital is a state-of-the-art emergency trauma center serving all major cruise lines and fly-in patients from all over the world.
Rafael Moguel’s Clinics of the Heart and it?s skilled and talented team of specialists perform a simple and safe procedure called percutaneous transluminal angioplasty (PTA) to treat the pelvic or penile arteries and a percutaneous transluminal coronary angioplasty or (PTCA) to treat the coronary arteries that studies reveal are directly affected with atherosclerosis. The vein is dissected along the penile shaft to the region of the glans, where several trunks coalesce to form it. Circumflex and direct emissary veins that drain into the deep dorsal vein are identified and divided between clamps or ligatures during the dissection to approximately 1 to 2 cm from the glans edge.

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