Erectile Dysfunction

Penile vascular surgery for the treatment of erectile dysfunction (ED) has been extensively studied over recent decades. It is still regarded with caution. We sought to provide an overview the publications and new developments in this field over the last century. Recent studies support a revised model of the tunica albuginea of the corpora cavernosa (CC) as a bi-layered structure with a 360° complete inner circular layer and a 300° incomplete outer longitudinal coat whereby penile erection-related vasculature interact with the tunica albuginea composed of multiple collagen bundles. Furthermore, additional studies demonstrate a more sophisticated venous drainage system than previously understood, and, most significantly, that the emissary veins can be easily occluded by the shearing action elicited by the inner and outer layers of the tunica albuginea. Pascal’s Law has been shown to be significant, if not the major factor in the erectile mechanics, with recent hemodynamic studies on fresh and defrosted human cadavers demonstrating rigid erections despite the lack of endothelial activity. Overall, reports on revascularization surgery support its utility in arterial trauma in young males, and with localized arterial occlusive disease in the older male. Penile venous stripping surgery has been shown to be beneficial in correcting veno-occlusive dysfunction, with outstanding results. The traditional complications of irreversible penile numbness and deformity have been virtually eliminated with the venous ligation technique superseding  Corresponding author: Geng-Long Hsu, MD, Microsurgical Potency Reconstruction and Research Center, 3F 88, Wen-Hu Street Nei-Hu Dt. 11445, Taipei, Taiwan; Phone: 886-2-87526087, Fax: 886-2-87975207, E-mail: [email protected]/[email protected]. The exclusive license for this PDF is limited to personal website use only. No part of this digital document may be reproduced, stored in a retrieval system or transmitted commercially in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services. Cheng-Hsing Hsieh and Geng-Long Hsu 130 venous cautery. Penile vascular reconstructive surgery is viable if, and only if, the surgical handling is properly carried out using a sound method. It ought to be promising in the near future.