External Mechanical Devices and Vascular Surgery for Erectile Dysfunction.

Published on Nov 1, 2016in The Journal of Sexual Medicine3.649
· DOI :10.1016/j.jsxm.2016.09.008
Landon Trost16
Estimated H-index: 16
(Mayo Clinic),
Ricardo Munarriz29
Estimated H-index: 29
(BU: Boston University)
+ 2 AuthorsLaurence A. Levine51
Estimated H-index: 51
(Rush University Medical Center)
Abstract Introduction The field of sexual medicine is continuously advancing, with novel outcomes reported on a regular basis. Given the rapid evolution, updated guidelines are essential to inform practicing clinicians on best practices. Aim To summarize the current literature and provide clinical guidelines on penile traction therapy, vacuum erection devices, and penile revascularization. Methods A consensus panel was held with leading sexual medicine experts during the 2015 International Consultation on Sexual Medicine (ICSM). Relevant literature was reviewed and graded based on Oxford criteria to develop evidence-based guideline and consensus statements. Main Outcome Measures The development of clinically relevant guidelines. Results Penile traction therapy is a viable therapy to modestly improve penile length as a primary therapy, before penile prosthesis placement in men with decreased penile length or after surgery for Peyronie's disease. It also might have a role in the acute phase of Peyronie's disease but has inconsistent outcomes in the long-term phase. Vacuum erection devices are effective in creating an erection satisfactory for intercourse, even in difficult-to-treat populations. They also might be used in the post-prostatectomy setting to maintain penile length but have insufficient evidence as a penile rehabilitation therapy. For vasculogenic erectile dysfunction, men with suspected arterial insufficiency can be evaluated with penile Duplex Doppler ultrasonography and confirmatory angiography. Penile revascularization procedures have consistently demonstrated benefits in very select patient populations; however, inadequate data exists to suggest the superiority of one technique. Men with vascular risk factors are likely poor candidates for penile revascularization, although veno-occlusive dysfunction and age are less significant. Therapies for treating primary veno-occlusive dysfunction are not recommended and should be reserved for clinical trials. Conclusions Since the prior ICSM meeting, multiple developments have occurred in external mechanical devices and penile revascularization for the treatment of erectile and sexual dysfunction. Sexual medicine clinicians are encouraged to review and incorporate recommendations as applicable to their scope of practice.
  • References (153)
  • Citations (10)
📖 Papers frequently viewed together
17 Citations
6 Citations
78% of Scinapse members use related papers. After signing in, all features are FREE.
#1Regula S. von Allmen (Kantonsspital St. Gallen)H-Index: 8
#2Daniel P. Nguyen (University of Bern)H-Index: 1
Last. Nicolas DiehmH-Index: 28
view all 7 authors...
Purpose: To determine the specific lesion pattern of supplying arteries in patients with cardiovascular risk factors suffering from treatment-refractory erectile dysfunction (ED). Methods: From May 2012 to August 2013, 26 men (median age 55 years) poorly responsive to phosphodiesterase-5 inhibitor therapy were evaluated for a possible vascular cause for their ED. The men were examined with penile duplex sonography and digital subtraction angiography (DSA). Arterial lesions in the common and inte...
3 CitationsSource
#1Faysal A. Yafi (Tulane University)H-Index: 16
#2Michael R. Pinsky (Tulane University)H-Index: 81
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 8 authors...
Purpose: The concomitant use of penile traction therapy with interferon α-2b has been previously described. We present an update on our clinical experience to assess the benefit and duration of daily traction.Materials and Methods: A retrospective review of patients who underwent interferon α-2b therapy between 2001 and 2012 was performed. Charts were reviewed and data collected regarding various patient demographics, vascular parameters, objective length and curvature measurements, and use of p...
27 CitationsSource
#1Faysal A. Yafi (Tulane University)H-Index: 16
#2Russell P. Libby (Tulane University)H-Index: 3
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 6 authors...
Summary Penile duplex Doppler ultrasound (PDDU) assesses the etiology of erectile dysfunction. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) are common PDDU parameters. We assessed whether stretched penile length (SPL) in the flaccid state and measured penile length at peak erection after intracavernosal injection (ICI) of a vasodilator during PDDU correlated with the etiology of erectile dysfunction. We performed a retrospective review of 93 patients who u...
5 CitationsSource
#1Matthew J. Pagano (CUMC: Columbia University Medical Center)H-Index: 4
#2Peter J. Stahl (CUMC: Columbia University Medical Center)H-Index: 6
Abstract Introduction Standard operating procedures (SOP) for penile duplex Doppler ultrasound (PDDU) were published in 2013 to promote uniform vascular assessment for erectile dysfunction (ED). However, SOPs do not specify a standard anatomic location for cavernosal artery (CA) imaging. Aim The aim of this study was to determine the effects of CA imaging location on measured penile hemodynamics assessed by PDDU. Methods PDDU was performed in men with ED and/or Peyronie's disease. CA peak systol...
11 CitationsSource
#1Marco Oderda (UNITO: University of Turin)H-Index: 13
#2Paolo Gontero (UNITO: University of Turin)H-Index: 32
Abstract Introduction Most men seeking penile enhancement techniques have a normal penile size. They are either misinformed or suffer from penile dysmorphophobia and should be discouraged from undergoing invasive procedures. Less invasive techniques including penile extenders are not associated with major complications and may be beneficial from a psychological perspective. Aim We conducted this study to assess the efficacy and safety of AndroPenis® (Andromedical, Madrid, Spain) penile extender....
10 CitationsSource
Objective: We evaluated the effectiveness of pelvic vein embolization with aethoxysclerol in aero-block technique for the treatment of impotence due to venous leakage in men using sildenafil for intercourse. The aim of the procedure was to reduce the use of sildenafil. Methods: A total of 96 patients with veno-occlusive dysfunction, severe enough for the need of PDE5 inhibitors for vaginal penetration, underwent pelvic venoablation with aethoxysclerol. The mean patient age was 53.5 years. Venous...
7 CitationsSource
#1Ali Dabaja (Cornell University)H-Index: 9
#2Patrick Teloken (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 12
Last. John P. Mulhall (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 60
view all 3 authors...
Abstract Introduction Penile revascularization (PR) is a potentially curative procedure for young men with isolated arteriogenic erectile dysfunction. Standard preoperative evaluation is erectile hemodynamics (HDX) using duplex Doppler penile ultrasound (DUS) and/or cavernosometry (DIC) and assessment of cavernosal arterial anatomy by selective internal pudendal arteriography (SIPA). Aim The aim of this study was to review our experience with men who sought a second opinion from us regarding the...
4 CitationsSource
#1Osama Shaeer (Cairo University)H-Index: 18
#2Kamal Shaeer (Cairo University)H-Index: 10
Abstract Introduction Complications of penile prosthesis implantation (PPI) are rare, nevertheless can be grave. In cases with veno‐occlusive dysfunction (VOD), alternative surgical techniques such as dorsal vein ligation (DVL) are controversial. Some patients may opt for trial at DVL to avoid the possible complications of PPI. However, this may be associated with disappointment if DVL fails and another procedure is required. Aim The aim if this study is to evaluate the results of a combined app...
2 CitationsSource
#1Alberto Rebonato (University of Perugia)H-Index: 7
#2Alessio AuciH-Index: 2
Last. Tito TorriH-Index: 6
view all 8 authors...
Abstract Purpose To evaluate retrospectively the safety and efficacy of anterograde embolization of the periprostatic venous plexus (AEPV) via percutaneous access of the deep dorsal vein of the penis for erectile dysfunction (ED) resulting from veno-occlusive dysfunction (VOD). Materials and Methods From September 2009 through December 2012, 18 patients with moderate to severe ED secondary to insufficiency of physiologic venous occlusion as diagnosed by color Doppler evaluation of the penis afte...
11 CitationsSource
#1Tzung-Dau Wang (NTU: National Taiwan University)H-Index: 25
#2Wen-Jeng LeeH-Index: 19
Last. Ming-Fong ChenH-Index: 36
view all 10 authors...
AIMS: Obstructive pelvic arterial lesions are highly prevalent in patients with erectile dysfunction and commonly located in penile artery segments. In this first-in-man study, we intended to assess the safety and feasibility of balloon angioplasty for isolated penile artery stenoses in patients with erectile dysfunction. METHODS AND RESULTS: Twenty-five patients with erectile dysfunction and isolated penile artery stenoses (unilateral stenosis ≥70% or bilateral stenoses ≥50%) identified by pelv...
15 CitationsSource
Cited By10
#1J.K. Akintunde (FUNAAB: Federal University of Agriculture, Abeokuta)
#2T.E. Akintola (FUNAAB: Federal University of Agriculture, Abeokuta)
Last. S.O. Adimchi (FUNAAB: Federal University of Agriculture, Abeokuta)
view all 5 authors...
Abstract This study investigated the effect of naringin (NRG) on extracellular metabolism of ATP through the NOS/cGMP/PKG signaling pathway induced by Nω-nitro-L-arginine methyl ester hydrochloride (L-NAME) on exposure to Bisphenol-A (BPA) in penis. Fifty-six adult male albino rats were randomly distributed into eight (n = 7) groups. Group I: control animals, Group II was treated with 40 mg/kg L-NAME, Group III was treated with 50 mg/kg BPA, Group IV was treated with 40 mg/kg L-NAME +50 mg/kg BP...
La disfuncion venoclusiva peneana (VOD), esta siendo reconocida como una causa importante de disfuncion erectil en especial en pacientes jovenes. Recientemente se han sugerido fisiopatologias novedosas y se han mejorado notablemente los metodos diagnosticos, lo que genera un campo en redescubrimiento con nuevos enfoques de tratamiento disponibles. La ligadura de fuga venosa dorsal ha tenido dificultades a traves de la historia para ser estandarizada. El articulo enfatiza que el diagnostico adecu...
#1Fuat Kizilay (Ege University)H-Index: 2
#2Serdar Kalemci (Ege University)
Last. Barış Altay (Ege University)H-Index: 11
view all 4 authors...
We aimed to correlate the predisposing demographic and clinical factors for erectile dysfunction (ED) in young men and treatment response in these men with data from older men. The patients were divided into two groups: /=40 years (group II, n = 73). ED was evaluated with the International Index of Erectile Function-5 (IIEF-5) questionnaire, and Beck's Depression Inventory (BDI) questionnaire was used to evaluate mood status. The number of patients with morning rigidity and normal libido was hig...
#1Cheng-Hsing Hsieh (TCU: Tzu Chi University)H-Index: 14
#2Geng-Long HsuH-Index: 18
Last. Ju-Ton Hsieh (NTU: National Taiwan University)H-Index: 16
view all 6 authors...
Penile erection implicates arterial inflow, sinusoidal relaxation and corporoveno-occlusive function. By far the most widely recognized vascular etiologies responsible for organic erectile dysfunction can be divided into arterial insufficiency, corporoveno-occlusive dysfunction or mixed type, with corporoveno-occlusive dysfunction representing the most common finding. In arteriogenic erectile dysfunction, corpora cavernosa show lower oxygen tension, leading to a diminished volume of cavernosal s...
1 CitationsSource
#1Afonso Morgado (University of Porto)H-Index: 1
#2Nuno TomadaH-Index: 7
view all 3 authors...
In this chapter the surgical treatment of erectile dysfunction and its historical perspective are reviewed. The standard surgical treatment of erectile dysfunction is the implantation of a penile prothesis, either semirigid or inflatable ones. Penile prothesis materials and design have improved along the last three decades, contributing to a lower rate of mechanical complications and an increased long-term durability. Both penile prothesis hydrophilic- and antibiotic impregnated-coatings, as wel...
#1Qiang GengH-Index: 1
#2Fu WangH-Index: 1
Last. Jun GuoH-Index: 1
view all 10 authors...
Objective To evaluate the effects of Xiaojin Pill (小金丸) in the treatment of Peyronie’s disease (PD) in a rat model.
Abstract Aim The aim of this study is to define an overview of the impact of SCI on male sexuality and provide a framework for the pathophysiology and the treatment of sexual dysfunction in male with SCI. Methods This scoping review was conducted to identificate pathophysiology and the treatment of sexual dysfunction in SCI male. Studies were identified by searching on PubMed, Web Of Science and Cochrane databases during January 2010-July 2018. Results Despite sexual dysfunction in men with SCI ...
Contemporary treatment algorithms for erectile dysfunction (ED) involve the use of medical therapies such as phosphodiesterase type 5 (PDE5) inhibitors and intracavernosal injection therapy of vasoactive agents, as well as vacuum erection devices and penile prosthesis implants in medically refractory cases. However, the current therapeutic options only address the symptoms of ED and not the underlying pathogenesis that results in ED. Newer and novel ED therapies aspire to reverse ED conditions b...
#1Matthew G. Cowper (Tulane University)
#2Connor B. Burkett (Tulane University)
Last. Wayne J.G. Hellstrom (Tulane University)H-Index: 63
view all 5 authors...
Abstract Introduction Peyronie’s disease (PD) is a debilitating condition that affects a sizable number of men worldwide. Current treatment options consist of oral therapy, intralesional injections, and surgery. Penile stretching has been used as a treatment for PD, including penile traction therapy (PTT) and vacuum erection devices (VEDs), with numerous trials completed or underway. Aim To present and summarize the current literature on penile stretching for the treatment of PD. Methods Using P...
#1Eduardo P. Miranda (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 5
#2Hisanori Taniguchi (MSK: Memorial Sloan Kettering Cancer Center)
Last. John P. Mulhall (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 60
view all 6 authors...
Abstract Background Although sex aids have been used in clinical practice for ages, the scientific literature assessing their application in men with sexual dysfunction is limited. Aim To summarize medical literature regarding scientific uses of the most common sex aids in men with sexual dysfunction and assess their clinical applicability. Methods An extensive literature review was performed with regard to the use of sex aids in sexual medicine. Our search included journal articles, books, and ...