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.

Impairment of shear-stress-mediated vasodilation of cavernous arteries in erectile dysfunction.

Penile NO release test (PNORT) has been designed to try to evaluate clinically the penile endothelial function (PEF). The shear-stress flow-mediated vasodilation (FMD) of the cavernous arteries is evaluated in two groups of patients with neurogenic (n=23) and vasculogenic (n=23) erectile dysfunction (ED) by measuring their percent of increase after a 5 min occlusion of the flow. Both groups show an important FMD decrease (17.

[Clinical models and decisional algorithm in the management of erectile disorders].

The diagnosis of erectile dysfunction (ED) needs an appropriate evaluation of global function and specific component of the erection. We have used a quantified methodology to grade each of the specific factors: arterial, venous, neurologic, endocrine, psychological and anxiety, in four groups of increasing severity. With this information each patient is them classified organic, psychological or mixed.

[Ambulatory treatment and prevention of priapism using alpha-agonists. Apropos of 172 cases].

From 1985 to 1995, 172 patients (149 on self intracavernous injection of vasoactive drugs, 16 with Sickle cell disease, 6 surgical patients under heparin therapy, and 1 after oral administration of trazodone), having experienced one or several episodes of priapism, lasting from 3 h to 8 days have been treated or submitted to self medication with alpha-agonist agents (eprephrine, phenylephrine or etilefrine) with an eventual drainage of the corporae. All episodes have disappeared and sexual function was preserved. A conservative treatment of priapism has been designed using corporal drainage and intracavernous etilefrine for acute priapism; as well as preventive treatment for those of the patients exposed to Sickle cell disease to avoid surgery and its frequent fribrotic sequelae, leading to impotence in 50% of the cases.

Intracavernous self-injection of vasoactive drugs in the treatment of impotence: 8-year experience with 615 cases.

Of 615 patients with impotence of varying etiologies who were followed from 12 to 96 months after the institution of intracavernous self-injection therapy with vasoactive drugs (papaverine alone, papaverine and alpha-blockers, and Ceritine, a new multilevel acting drug) 87% (533 patients) returned for followup visits or were regularly contacted. Of these patients sexual activity was restored in 91%. The dropout rate was 11.