madman
Super Moderator
Abstract: 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 shows 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 the 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 innovative 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.
Critical guideline issued In 2015, the panel in the fourth Paris International Consultation on Sexual Medicine concluded that venous surgery or embolization is not recommended for the treatment of CVOD; regardless, the procedures can be carried out under the circumstances of clinical research with informed consent, standardized methods of diagnosis and surgical treatment. Standardized questionnaires (IIEF) and long-term (a minimum of 24 months) follow up are also required (LOE = 4; strength of recommendation = C; option).33 In 2018, the American Urological Association Guidelines Panel proclaimed that penile venous surgery is not recommended for patients with ED (moderate recommendation; evidence level: grade C).91 The European Association of Urology guidelines on ED, premature ejaculation, penile curvature, and priapism also disclaimed penile venous surgery to be an option for management of ED.92
Conclusions
Nowadays, there is no convincing evidence available to draw conclusions that supplant these guidelines recommended by the panels on ED. Numerous physicians query whether or not penile vascular surgery addresses the underlying pathology. Sarcastically, the same concern should apply to current options recommended in the guidelines. Integration or combination of vascular surgery into goal-approached therapies, which include psychological counseling, medical (e.g. phosphodiesterase type 5 inhibitor and intracavernosal injection), non-surgical (e.g. vacuum device and low-intensity shock wave therapy), and alternative surgical intervention (e.g. penile prosthesis), would optimize patient-centered management strategies. It is noteworthy that penile venous surgery might be beneficial to selected patients with CVOD, especially with a better understanding of the innovative venous anatomy of the penis. To afford opportunities for the improvement of ED, penile vascular surgery remains a viable option and has found its niche in the possibility of obtaining spontaneous, unaided, and natural erection.
Critical guideline issued In 2015, the panel in the fourth Paris International Consultation on Sexual Medicine concluded that venous surgery or embolization is not recommended for the treatment of CVOD; regardless, the procedures can be carried out under the circumstances of clinical research with informed consent, standardized methods of diagnosis and surgical treatment. Standardized questionnaires (IIEF) and long-term (a minimum of 24 months) follow up are also required (LOE = 4; strength of recommendation = C; option).33 In 2018, the American Urological Association Guidelines Panel proclaimed that penile venous surgery is not recommended for patients with ED (moderate recommendation; evidence level: grade C).91 The European Association of Urology guidelines on ED, premature ejaculation, penile curvature, and priapism also disclaimed penile venous surgery to be an option for management of ED.92
Conclusions
Nowadays, there is no convincing evidence available to draw conclusions that supplant these guidelines recommended by the panels on ED. Numerous physicians query whether or not penile vascular surgery addresses the underlying pathology. Sarcastically, the same concern should apply to current options recommended in the guidelines. Integration or combination of vascular surgery into goal-approached therapies, which include psychological counseling, medical (e.g. phosphodiesterase type 5 inhibitor and intracavernosal injection), non-surgical (e.g. vacuum device and low-intensity shock wave therapy), and alternative surgical intervention (e.g. penile prosthesis), would optimize patient-centered management strategies. It is noteworthy that penile venous surgery might be beneficial to selected patients with CVOD, especially with a better understanding of the innovative venous anatomy of the penis. To afford opportunities for the improvement of ED, penile vascular surgery remains a viable option and has found its niche in the possibility of obtaining spontaneous, unaided, and natural erection.
