An Atlas of Erectile Dysfunction

Cover Page......Page 1
Title Page......Page 3
ISBN 0203008928 (ebook), 1842142410......Page 4
Contents......Page 5
Foreword......Page 6
Preface......Page 7
Section I: A Review of Erectile Dysfunction......Page 8
Introduction......Page 10
VENOUS DRAINAGE......Page 11
CENTRAL NERVOUS SYSTEM CONNECTIONS......Page 12
REGULATION OF INTRACAVERNOSAL SMOOTH MUSCLE CONTRACTILITY......Page 13
HEMODYNAMICS OF ERECTION......Page 14
ORGASM AND EJACULATION......Page 15
VASCULOGENIC CAUSES......Page 16
NEUROGENIC CAUSES......Page 17
ENDOCRINOLOGICAL CAUSES......Page 18
PSYCHOGENIC CAUSES......Page 19
Epidemiology of erectile dysfunction......Page 20
PEYRONIE’S DISEASE......Page 21
DEPRESSION......Page 22
HISTORY......Page 23
SPECIAL INVESTIGATIONS......Page 24
MEDICAL THERAPIES......Page 26
SURGICAL THERAPIES......Page 29
Conclusions......Page 31
Bibliography......Page 32
Appendix......Page 35
Figure 1 Key structures mediating erection are the corpora cavernosa or ‘erectile bodies’, which are fused distally for approximately three-quarters......Page 39
Figure 3 The corpus spongiosum is firmly attached to the undersurface (ventral aspect) of the corpora cavernosa and expands distally to......Page 40
Figure 4 Muscles of the pelvic floor surround and support the erectile bodies and corpus spongiosum. In terms of sexual function, the most......Page 41
Figure 6 The pendulous portion of the penis is supported by the suspensory ligament, a fibrous condensation which supports and stabilizes......Page 42
Figure 7 Blood supply to each corpus cavernosum is derived from the internal iliac artery, a branch of the common iliac artery; the internal......Page 43
Figure 9 Cross-section of the penis showing the locations of the paired dorsal arteries and cavernosal arteries. Note the helicine arteries, which......Page 44
Figure 11 Venous drainage from the corpora cavernosa takes place mainly through the deep dorsal vein, which lies dorsally in the groove......Page 45
Figure 13 Locally advanced squamous cell carcinoma of the penis. In this case, the inguinal lymph nodes were involved bilaterally.......Page 46
Figure 14 Three sets of peripheral nerves are involved in penile erection: two are autonomic and one is somatic. Parasympathetic nerves......Page 47
Figure 15 The hypogastric nerves are vulnerable during retroperitoneal lymph node dissection. Both sympathetic and parasympathetic......Page 48
Figure 16 Cavernosal smooth muscle tone is the most important determinant of penile blood flow. This, in turn, is critically dependent on......Page 49
Figure 17 Vasodilatory actions of nitric oxide (NO), prostaglandin E1 and vasoactive intestinal polypeptide (VIP) and the opposing......Page 50
Figure 18 Norepinephrine is released from dense-core vesicles in sympathetic nerve terminals within the corpora. Norepinephrine then......Page 51
Figure 19 Second-messenger systems following stimulation of α-adrenoceptors on the membranes of smooth muscle cells within the......Page 52
Figure 21 Neurohistochemical preparation of a microscopy section of dog corpus cavernosum demonstrates the presence of nitric oxide......Page 53
Figure 23 Smooth muscle architecture and vascular endothelium of the walls of the lacunar spaces within the corpora. Relaxation of these......Page 54
Figure 24 Hemodynamics of flaccidity. (a) Tonic contraction of the walls of the helicine arteries and trabeculae allows only relatively small......Page 55
Figure 25 Schematic representation of the hemodynamics of flaccidity and erection. The key event in the induction of erection is vasodilatation......Page 58
Figure 27 Mechanism of ejaculation: ejaculation is a reflex response involving both sympathetic and pudendal nerve activity. Sympathetic......Page 59
Figure 28 An atheroma affecting both common iliac arteries results in vascular insufficiency, a major cause of erectile dysfunction......Page 60
Figure 29 Dynamic infusion cavernosometry and cavernosography show a venous leak (arrowed) into the pelvic veins......Page 61
Figure 30 Deleterious effects of low oxygen (O2) levels on intracorporeal smooth muscle. Low O2 tension promotes the release of......Page 62
Figure 32 Progressive decrease in free testosterone levels with age. In some men, the lack of testosterone may be associated with a loss of......Page 63
Figure 33 Magnetic resonance imaging with gadolinium enhancement ((a) anteroposterior view; (b) lateral view) of a pituitary tumor......Page 64
Figure 34 Priapism in a patient who also had a carcinoma of the prostate gland, and hence the need for a suprapubic catheter Figure 35 The projected world population pyramid for 2002 (green) and 2025 (white) demonstrating how many more older people will be......Page 65
Figure 36 The proportion of men with either complete, moderate or minimal erectile dysfunction in the Massachusetts Male Aging Study Figure 37 Negative effects of erectile dysfunction on men’s quality of life......Page 66
Figure 38 Cavernosogram showing the typical dorsal deformity seen in Peyronie’s disease as well as a venous leak (arrowed) into the deep......Page 67
Figure 40 Erythroplasia of Queyrat involving the glans penis......Page 68
Figure 41 Early squamous cell carcinoma of the penis typically presents as an ulcerative lesion Figure 42 Balanitis xerotica obliterans is a dermatological condition that affects the prepuce, causing phimosis. It may spread to the glans......Page 69
Figure 44 Testicular tumor. (a) The testis is expanded. These are most commonly seen in men 20–40 years of age; (b) on palpation, the tumor......Page 70
Figure 46 Nocturnal penile tumescence trace from a man with erectile dysfunction showing a lack of tumescence during sleep, suggesting......Page 71
Figure 48 An erection induced by intracavernous injection of 20 mg of alprostadil (prostaglandin E1). Such an erection may last from 30......Page 72
Figure 49 Color duplex Doppler ultrasonography (CDDU). (a) The probe is placed on the penis, which has been lubricated with ultrasound......Page 73
Figure 50 Color duplex Doppler ultrasonography (CDDU) of a patient with (a) arteriogenic erectile dysfunction shows poor tumescence, a......Page 74
Figure 51 Dynamic infusion cavernosography and cavernosometry show venous leakage into the deep dorsal vein (arrowed) and corpus......Page 75
Figure 52 Dynamic infusion cavernosography and cavernosometry show venous leakage into the deep dorsal vein (small arrow) and deep......Page 76
Figure 54 Incidence of patients reporting difficulty in either obtaining or maintaining an erection in a 4-year comparative study of......Page 77
Figure 55 The mechanism of action of dopamine agonists in men with erectile dysfunction Figure 56 The chemical structures of dopamine and apomorphine......Page 78
Figure 57 The efficacy of apomorphine at the 3 mg dosage, as reported by patients and their partners Figure 58 Mechanism of action of sildenafil (Viagra®): nitric oxide (NO) is produced by the enzyme nitric oxide synthase (NOS), found in......Page 79
Figure 60 Percentages of patients reporting improved erections while receiving sildenafil treatment in a 36-week open-label extension study......Page 80
Figure 62 The most commonly occurring all-causes and treatment-related adverse events occurring during longterm open-label sildenafil......Page 81
Figure 64 Effects of tadalafil on successful intercourse completion with time after dosing, as measured by Sexual Encounter Profile,......Page 82
Figure 66 Vardenafil is effective in men after radical prostatectomy. Percentage of patients with bilateral nervesparing prostatectomy......Page 83
Figure 67 Medicated urethral system for erection (MUSE): using a special applicator, a 125, 250, 500 or 1000 mg suppository of......Page 84
Figure 69 The vacuum device to induce tumescence is based on a simple concept. The device is lubricated with jelly around the rim to......Page 85
Figure 70 Correction of a venous leak into the deep dorsal vein (DDV) may sometimes be achieved by excision of a segment of the DDV:......Page 86
Figure 71 Arterial revascularization of the corpora may be applicable in some younger patients with localized lesions of the pudendal artery......Page 88
Figure 72 Semi-rigid penile prosthesis: the stainless-steel core renders the device capable of retaining its position in whichever position it is......Page 89
Figure 74 Inflatable one-piece penile prosthesis: this device confers some degree of flaccidity but is not always easy to inflate and deflate......Page 90
Figure 75 Inflatable one-piece penile prosthesis in situ: inflation is achieved by squeezing the distally located inflation pump......Page 91
Figure 76 Two-component inflatable penile prosthesis: deflation is achieved by transfer of fluid from the two cylinders implanted in the......Page 92
Figure 77 Three-component inflatable penile prosthesis: this device produces the most cosmetically and functionally acceptable results......Page 93
Figure 79 Surgical implantation of a three-component inflatable penile prosthesis: after scrupulous skin cleansing and administration of......Page 94
Figure 81 Surgical implantation of a three-component inflatable penile prosthesis: each corpus is incised longitudinally to expose the......Page 95
Figure 83 Surgical implantation of a three-component inflatable penile prosthesis: the proximal corporal spaces are similarly dilated and the......Page 96
Figure 84 Surgical implantation of a three-component inflatable penile prosthesis: silicone cylinders of the correct length are implanted (a),......Page 97
Figure 86 Surgical implantation of a three-component inflatable penile prosthesis: the corporotomy is closed while ensuring that the......Page 98
Figure 88 Portrait of François de la Peyronie, the eminent French surgeon who gave his name to the fibrotic condition which frequently......Page 99
Figure 89 Dorsal penile deformity (a) as a result of a Peyronie’s plaque, demonstrated by the creation of an artificial erection immediately......Page 100
Figure 90 An alternative surgical corrective technique for Peyronie’s deformity involves multiple plication of the corpora. Multiple non-absorbable......Page 101
Figure 91 To avoid the inevitable penile shortening that accompanies Nesbit’s operation, an alternative procedure has been described. The......Page 102
Figure 92 Another procedure to correct penile curvature due to Peyronie’s disease without associated penile shortening involves dissection......Page 103
Figure 93 In this procedure to achieve apparent penile lengthening, a V-Y plasty skin incision is made to lower the penis relative to the......Page 104
Index......Page 105