Erectile Dysfunction Resistant to Medical Treatment Caused by Cavernovenous Leakage: An Innovative Surgical Approach Combining Pre-operative Work Up, Embolisation, and Open Surgery.

OBJECTIVE: Thirty per cent of cases of erectile dysfunction (ED)/male impotence are resistant to oral treatment. Half of these cases are due to blood drainage from the corpora cavernosa occurring too soon, due to cavernovenous leakage (CVL). The aim of this study was to report on an innovative treatment scheme combining pre- and post-operative haemodynamic assessment, venous embolisation, and open surgery for drug resistant ED caused by CVL. METHODS: An analysis of prospectively collected data, with clinical and haemodynamic pre- and post-operative assessment, was carried out. Forty-five consecutive patients operated on for drug resistant ED caused by CVL were evaluated pre-operatively and three months post-operatively by pharmacologically challenged penile duplex sonography (PC-PDS), pharmacologically challenged Erection Hardness Score (PC-EHS), and pharmacologically challenged computed caverno tomography (PC-CCT). Follow up consisted of patient interview, PC-PDS, PC-EHS and if needed PC-CCT. RESULTS: Mean patient age was 43.9 ± 12.0 years (range 20-67). Forty-nine per cent of patients had primary ED. Patients with diabetes, a smoking habit, hypercholesterolaemia, and hypertension were 18%, 11%, 9%, and 4%, respectively. Three months post-operatively, PC-EHS increased from 2.0 ± 0.7 to 3.1 ± 0.74 (p < .001), with an EHS of 3 being the threshold allowing for penetration. Deep dorsal vein velocity, a haemodynamic marker of CVL, decreased from 14.2 ± 13.0 to 0.9 ± 3.5 cm/s (p < .001). After a 14.0 ± 10.7 month follow up, the primary success rate (clinical EHS ≥ 3, possible sexual intercourse with penetration, no vascular re-operation, no penile prosthesis implant) was 73.3%. Four patients (9%) underwent successful re-operation for persistent ED and CVL. Accordingly, compared with a possible penetration rate of 8.9% before surgery, 37 patients (secondary success rate: 82.2%) were able to achieve sexual intercourse with penetration. Type of ED (primary vs. secondary) and diabetes had no influence on the results. Thirty-two per cent of patients with secondary success achieved penetration with no medication. CONCLUSIONS: After a 14 month follow up, pre-operative work up, embolisation, and open surgery during the same procedure allowed patients with ED resistant to oral medical to achieve intercourse with penetration.

[Essentials of the differentiation and standardization of syndromes for male impotence in Xu Fu-song's clinical experience].

OBJECTIVE: To analyze the essentials of the differentiation and standardization of syndromes for male impotence in Xu Fu-song's clinical practice. METHODS: We conducted a randomized survey of 183 cases of male impotence diagnosed and treated at Professor Xu Fu-song's Clinic. We collected the data on the four diagnostic methods of traditional Chinese medicine (TCM), namely, observation, auscultation and olfaction, inquiry, and pulse feeling and palpation, and subjected them to principal component and factor analyses. RESULTS: Eleven common factors were extracted in the principal component and factor analyses, which were in accordance with Xu Fu-song's clinical practice. Based on the results of the analysis of the 11 factors, male impotence is differentiated as 11 syndrome types as follows: damp-heat syndrome, with the manifestations of bitter taste, scrotal moisture, reddish yellow urine, dribbling urination, frequent urination, urgent urination, sticky stool, red tongue, yellow greasy fur, rapid pulse, slippery pulse, and soggy pulse; kidney-yin deficiency syndrome, featured by polyhidrosis of hands and feet, night sweating, cold drink preference, dry mouth, red tongue, less fur, thready pulse, and rapid pulse; liver-qi stagnation syndrome, presented as depression, anxiety, introvert, dark tongue, and stringy pulse; phlegm turbidity syndrome, shown as sticky mouth, phlegmy mouth, throat discomfort, chest congestion, gastric fullness, low sexual desire, white greasy fur, and slippery pulse; kidney-yang deficiency syndrome, manifested as intolerance of cold, mental fatigue, lower abdominal cold, nocturnal enuresis, hot drink preference, pale tongue, and deep pulse; lung and spleen deficiency syndrome, with the presentations of cough, easy cold, spontaneous sweating, nasal stuffiness, pale tongue, and thready pulse; qi stagnation and blood stasis syndrome, characterized by lower abdominal pain, perineal or testicular prolapse, purple tongue, and deep pulse; heart-kidney disharmony syndrome, distinguished by insomnia, gonobolia, premature ejaculation, red tongue, and thready pulse; heart and spleen deficiency syndrome, featured by palpitation, amnesia, pale complexion, pale tongue, and deep pulse; spleen and kidney deficiency syndrome, manifested as dizziness, pale complexion, pale tongue, deep pulse, and thready pulse; lung and kidney deficiency syndrome, characterized by five-center dysphoria, tinnitus, general heaviness, pale tongue, less fur, and thready pulse. CONCLUSIONS: The syndromes of male impotence are regularly differentiated and standardized in Xu Fu-song's clinical practice, each with its core symptoms and typical tongue and pulse manifestations.

Shockwave treatment of erectile dysfunction.

Low-intensity extracorporeal shock wave therapy (LI-ESWT) is a novel modality that has recently been developed for treating erectile dysfunction (ED). Unlike other current treatment options for ED, all of which are palliative in nature, LI-ESWT is unique in that it aims to restore the erectile mechanism in order to enable natural or spontaneous erections. Results from basic science experiments have provided evidence that LI-ESWT induces cellular microtrauma, which in turn stimulates the release of angiogenic factors and the subsequent neovascularization of the treated tissue. Extracorporeal shock wave therapy (ESWT) has been clinically investigated and applied in several medical fields with various degrees of success. High-intensity shock wave therapy is used for lithotripsy because of its focused mechanical destructive nature, and medium-intensity shock waves have been shown to have anti-inflammatory properties and are used for treating a wide array of orthopedic conditions, such as non-union fractures, tendonitis, and bursitis. In contrast, LI-ESWT has angiogenetic properties and is therefore used in the management of chronic wounds, peripheral neuropathy, and in cardiac neovascularization. As a result of these characteristics we initiated a series of experiments evaluating the effect of LI-ESWT on the cavernosal tissue of patients with vasculogenic ED. The results of our studies, which also included a double-blind randomized control trial, confirm that LI-ESWT generates a significant clinical improvement of erectile function and a significant improvement in penile hemodynamics without any adverse effects. Although further extensive research is needed, LI-ESWT may create a new standard of care for men with vasculogenic ED.