Surgery erectile dysfunction

Unlabeled Uses Treatment of pralidoxime-induced hypertension, arrhythmias, asthma, bladder instability, cardiac diseases, diabetes mellitus, erectile dysfunction, extravasation (dopamine and epinephrine), hyperhidrosis, myocardial infarction, Raynaud s phenomenon, surgery, sympathetic pain... 

Erectile dysfunction, that is, the inability to maintain penile erection for the successful performance of sexual activity, has both organic and psychogenic causes, including as a sequelae to prostatic surgery. Erectile dysfunction is estimated to affect up to 30 million men in the United States. Previous therapies have included penile implants, and intrape-nile injections of alprostadil (see p. 420). Sildenafil [sil DEN a HI], the first oral drug approved for the treatment of erectile dysfunction in males, was introduced in early 1998. 

Societal changes also affect you. While the Pill would probably not be approved today, it sells well but more and more men and women want a pill for men. Viagra should not have been actively researched, but it found its indication of erectile dysfunction, common in diabetic men. Recently, some physicians have begun using Viagra and its competitors after prostate surgery with promising results. 

Specific treatments for erectile dysfunction include medical devices, pharmacologic treatments, psychotherapy, and surgery. 

I Specific treatments for erectile dysfunction include medical devices, pharmacologic treatments, and surgery. The ideal treatment for this disorder should have a fast onset, be effective, be convenient to administer, be cost-effective, have a low incidence of serious adverse effects, and be free of serious drug interactions. 

VEDs may also be used as second-line therapy in patients who fail oral or injectable drug treatments for erectile dysfunction. The combination of VED with intracavernosaF or intraurethraP al-prostadil is associated with a higher rate of efficacy than use of the VED alone. As a result, combination therapy may sometimes be attempted before surgery is considered in the patient who fails VED monotherapy. 

Surgery is the gold standard of treatment, as it is the only intervention that relieves symptoms in the greatest number of men with BPH. However, the two most widely used techniques are associated with the highest rates of complications, including retrograde ejaculation and erectile dysfunction. 

The main source of blood supply to the penis (Fig. 2.2a) is usually through the internal pudendal artery, a branch of the internal iliac artery. In many instances, however, accessory arteries arise from the external iliac, obturator, vesical, and/or femoral arteries, and may occasionally become the dominant or only arterial supply to the corpus cavernosum (Breza et al. 1989). Damage to these accessory arteries during radical prostatectomy or cystectomy may result in vasculogenic erectile dysfunction (ED) after surgery (Aboseif et al. 1994 Kim et al. 1994). 

Detailed evaluation of the penile vascular supply is mandatory to plan intervention in patients with postraumatic erectile dysfunction who are candidates for penile revascularization surgery. These patients are frequently young, have often suffered traumatic straddle injuries to the pelvis and may be unresponsive to oral and intracaver-nosal therapy (Golijanin et al. 2007a Golijanin et al. 2007b). 

Patients with vertebral, pelvic or perineal injuries and patients undergoing extensive pelvic surgery can present with posttraumatic erectile dysfunction (Machtens et al. 2001). 

Peyronie s disease is the most frequent cause of acquired penile curvature with an estimated prevalence of 0.4% in Caucasian men (Montorsi et al. 2000 Lindsay et al. 1991). No medical therapy is fully effective, and surgery remains the gold standard in patients with severe deformity and/or erectile dysfunction who fail conservative measures. The indications for surgical correction of penile bending include severe curvature, narrowing, or indentation, and severe penile shortening of more than 1 year duration with sexual difficulty or partner discomfort because of deformity (Gholami and Lue 2001). 

Mukherjee GD (1980) The rise of surgery from empiric craft to scientific discipline. Plast Reconstr Surg 65 531 Munarriz RM, Yan QR, A ZN, et al. (1995) Blunt trauma the pathophysiology of hemodynamic injury leading to erectile dysfunction. J Urol 153 1831-1840 Narayana AS, Olney LE, Loening SA, et al. (1982) Carcinoma of the penis analysis of 219 cases. Cancer 49 2185-2191 Newman HF, Reiss H (1982) Method for exposure of cavernous artery. Urology 19 61-62... 

Treiber U, Gilbert P (1989) Venous surgery in erectile dysfunction a critical report on 116 patients. Urology 34 22-27... 

In patients with corporeal plication ultrasonography shows small lumps next to the albugineal sutures extending within the corpora cavernosa (Bertolotto et al. 2005). In patients with normal erection before surgery after shortening procedures, postoperative erectile dysfunction is uncommon. When present, color Doppler interrogation allows evaluation of the penile arteries and identification of leakage pathways. 

---