The vascular and neurogenic factors associated with erectile dysfunction in patients after pelvic fractures.

Erectile dysfunction (ED) is a common complication of pelvic fractures. To identify the vascular and neurogenic factors associated with ED, 120 patients admitted with ED after traumatic pelvic fracture between January 2009 and June 2013 were enrolled in this study. All patients answered the International Index of Erectile Function (IIEF-5) questionnaire. Nocturnal penile tumescence (NPT) testing confirmed the occurrence of ED in 96 (80%) patients on whom penile duplex ultrasound and neurophysiological testing were further performed. Of these ED patients 29 (30%) were demonstrated only with vascular abnormality, 41 (42.7%) were detected only with neural abnormality, 26 (27.1%) revealed mixed abnormalities. Of the 55 patients (29+26) with vascular problems, 7 patients (12.7%) with abnormal arterial response to intracavernous injection of Bimix (15mg papaverine and 1mg phentolamine), 31 (56.4%) with corporal veno-occlusive dysfunction and 17 (30.9%) had both problems. Of the 67 (41+26) patients with abnormal neurophysiological outcomes, 51 (76.1%) with abnormal bulbocavernosus re?ex (BCR), 20 (29.9%) with pathological pudendal nerve evoked potentials (PDEPs) and 25 (37.3%) with abnormal posterior tibial somatosensory nerve evoked potentials (PTSSEPs). Our observation indicated that neurogenic factors are important for the generation of ED in patients with pelvic fracture; venous impotence is more common than arteriogenic ED.

SOP: corpus cavernosum assessment (cavernosography/cavernosometry).

INTRODUCTION: There is no universal gold standard diagnostic test to differentiate psychogenic from organic erectile dysfunction (ED). Cavernosography/cavernosometry has been used to evaluate veno-occlusive dysfunction (VOD) in men with a proposed organic ED. AIM: To develop evidence-based guidelines for the performance and interpretation of cavernosography/cavernosometry. METHODS: Review the methodology behind cavernosography/cavernosometry and evaluate the evidence that supports its use and interpretation of results. MAIN OUTCOME MEASURE: Expert opinion based on review of the literature, extensive internal committee discussion, public presentation, and debate. RESULTS: The detailed technique of cavernosography/cavernosometry is described. An evidence-based perspective to the use and interpretation of cavernosometry is presented. CONCLUSION: The positive predictive value of cavernosometry still needs further assessment. It is unknown how many potent men would test positive for VOD (false positive).

[Duplex-color sonography in the evaluation of erectile dysfunction of vascular origin]. / Sonografia Duplex-Color en la evaluación dé la disfunción erectil de origen vascular.

The authors review the penile ultrasound records of 47 patients referred from the Urology Service with a diagnosis of Erectile Dysfunction. The pear systolic and and diastolic pressures were measured every 5 minutes for 30 minutes after the intracavernous injection of 60 mg of Papaverine, as well as the diameter of the cavernous arteries before and after the injection which was made using a 25 gauge needle. A tourniquet was applied at the base of the penis while injecting and was kept in place for 2 minutes after the injection was completed. The results were normal in 16 (34.04%) and abnormal in 31 (65.95%) patients. Of these, 27 (87.1%) had an abnormal vascular response and in 4 (12.9%) it was of an undetermined type. The abnormal vascular response was due to arterial insufficiency in 12 (44%) and to venous insufficiency in 15 (56%). The authors also found that the diameter of the cavernous arteries increased 15% to 120% (-/+ = 68%) in the patients with normal studies, 17% to 100% (-/+ = 58.1%) in those with arterial insufficiency and 23% to 89% (-/+ = 52.3%) in those with signs of venous insufficiency.