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 Anatomy and Physiology of Normal Erection

Anatomy

  • Arterial anatomy.
  • Venous drainage.
  • Penile innervation.

Hemodynamics of normal erection

Causes of impotence

  • Cavernosal malfunction.
  • Venous or cavernosal leakage.
  • Arteriogenic impotence.

Diagnostic methods

  • Noninvasive sequence (penile brachial blood pressure index, penile plethysmographic pulse recording, pudental-evoked potentials, bulbo-cavernosal reflex time).
  • Artificial erection.
  • Dynamic infusion cavernosometry and cavernosography.
  • Ultrasonography.
  • Nocturnal penile tumescence.

Treatment of vasculogenic impotence

  • Drug therapy.
  • Small vessel reconstruction.
  • Venous interruption.
  • Prosthetics.

References

Simonsen U, Garcia-Sacristan A, Prieto D. Penile arteries and erection. J Vasc Res 2002;39:283-303.

The anatomy of the penile vasculature and the physiology of erection are reviewed in this paper. Risk factors for vasculogenic erectile dysfunction are also briefly discussed.

Moreland RB. Pathophysiology of erectile dysfunction: the contributions of trabecular structure to function and the role of functional antagonism. Int J Impot Res 2000;12 Suppl 4:S39-46.

At present, there are two major views regarding the pathophysiology of erectile dysfunction. In the first hypothesis, the oxygen tension-dependent changes in the penis during erection are proposed to impact corpus cavernosum structure by altering smooth muscle metabolism and connective tissue synthesis. The alternate hypothesis proposes that ED is the result of a metabolic imbalance between relaxatory and contractile processes within the trabecular smooth muscle such that contractile processes predominate. In this review of the pathophysiology of ED, each hypothesis is examined and a synthesis devised incorporating both views.

Maggi M, Filippi S, Ledda F, Magini A, Forti G. Erectile dysfunction: from biochemical pharmacology to advances in medical therapy. Eur J Endocrinol 2000;143:143-154.

This article focuses on the main biochemical events leading to penile erection and detumescence as well as on the potential manipulation of these events for therapeutic purposes. The role of nitric oxide, cGMP, cAMP and phosphodiesterases is analyzed and potential pharmacologic interventions including papaverine, sildenafil and yohimbine are discussed.

Broderick GA. Evidence based assessment of erectile dysfunction. Int J Impot Res 1998;10 Suppl 2:S64-73; discussion S77-9.

The most commonly utilized diagnostic tests for erectile dysfunction are outlined in this monograph. These tests include nocturnal penile tumescence studies, somatosensory evoked potentials, bulbocavernosus reflex latency, corporal cavernosal smooth muscle electrical activity, penile plethysmography, penile blood pressures, penile brachial index, selective internal pudendal pharmacoangiography, Doppler sonography, dynamic infusion cavernosometry/cavernosography, nuclear washout radiography, and color duplex Doppler ultrasound.

DePalma RG. Vascular surgery for impotence: a review. Int J Impot Res 1997;9:61-67.

This review considers current and past results of vascular surgery in men with impotence failing to respond to medical treatment. Guidelines for case selection for vascular interventions as well as reporting criteria are suggested.

Posted June 2010