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ABSTRACT: To evaluate the outcome at long term follow-up after straightening corporoplasty of penile curvature due to Peyronie's disease.
Between 1986 and 2001 a total of 279 patients with Peyronie's disease were operated on using the Nesbit procedure. We were able to obtain complete follow-up data in 218 patients. The follow-up data included evaluation of complete correction of the curvature, penile shortening, sexual function, complications and subjective patient satisfaction.
After a median follow-up of 89 months subjective patient determination of satisfaction indicated that 83.5% were completely satisfied with the results of surgery. Complete correction of the penis was obtained in 86.3% of the patients. One hundred and ninety patients (87.1%) had good erectile function (IIEF-5 >21). Shortening of the penis (from 1.5 to more than 3 cm) occurred in 38 patients (17.4%), but only in 5 (2.3%) was intercourse difficult because of excessive shortening. Major sensory changes, confined to the glans area, were reported by 24 patients (11%).
The Nesbit operation is a simple and safe technique to correct the penile deformity due to Peyronie's disease. This technique results in the greatest amount of patient satisfaction about erectile function. The procedure can be used to correct all degrees of penile curvature successfully except for the short penis. Informed consent should be amply discussed before operating in regard to the risk of penile shortening and major sensory changes of the glans area.
European Urology 11/2004; 46(5):610-4; discussion 613-4. · 8.49 Impact Factor
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ABSTRACT: We present 15 cases of high flow priapism treated by selective embolization and evaluate erectile function at long-term followup.
Between 1995 and 2001, 15 patients underwent highly selective embolization of the cavernous artery for high flow priapism. Trauma was reported by 12 of the 15 patients, and no etiologic causes were evident in the other 3. The fistula was unilateral in 13 patients and bilateral in 2. All patients underwent embolization during arteriography. Erectile function was determined using the International Index of Erectile Function (IIEF) at followup after an average of 55 months (range 18 to 93).
Postoperative color Doppler ultrasonography showed no recurrence in 11 patients (73%). Repeat pelvic angiography with selective embolization was required at 1 month postoperatively in 3 patients (20%). In 1 case (7%) 3 consecutive embolizations were not conclusive and a surgical operation was required. The IIEF results showed that sexual function was in the normal range in 80% of patients. Three patients (20%) reported a slight change in the quality of erection. Mean postoperative IIEF score was 26.3 (range 18 to 30).
Highly selective embolization of the fistula is an effective and safe treatment option for high flow priapism because it ensures a high level of preservation of pretreatment erectile function.
The Journal of Urology 09/2004; 172(2):644-7. · 3.75 Impact Factor
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ABSTRACT: Our objective was to investigate prevalence and Doppler characteristics of penile cavernosal-spongiosal communications (CSC). These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels to the corpus spongiosum. Sixty-one consecutive patients underwent penile color Doppler US. Waveform changes in CSC were evaluated in comparison with changes in the cavernosal artery. Eighteen of 61 patients had normal erection, 17 of 61 had arterial insufficiency, and 26 of 61 had veno-occlusive dysfunction. Resistance index (RI) in CSC was significantly lower than in cavernosal arteries in all patients and increased during phases 1-2 (positive diastolic flow). Peak systolic velocity (PSV) in CSC was significantly higher in the patients with veno-occlusive dysfunction. During cavernosal phase 4 (diastolic flow reversal) CSC of patients with normal erection or with arterial insufficiency disappeared, underwent markedly reduced diastolic flow, or had systolic flow inversion. Conversely, low resistance flow was appreciable in CSC of patients with veno-occlusive dysfunction who reached phase 4. During phase 5 (systolic peak reduction) all CSC disappeared. Color Doppler US allows evaluation of CSC both in patients with normal and impaired erection.
European Radiology 10/2002; 12(9):2287-93. · 3.22 Impact Factor
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ABSTRACT: To determine the long-term follow-up of treatment of high-flow priapism, we reviewed the case records of 10 patients who were examined by the Urologic Clinic in Trieste from 1995 to 1998. High-flow or arterial priapism is a fairly rare dysfunction, generally resulting from penile or perineal trauma. In some cases, the etiology remains unknown.
Trauma was reported in 6 of 10 cases. No etiologic causes were evident in the other patients. Nine patients underwent selective embolization during arteriography, and in 1 patient, corporotomy and ligature of the cavernous artery were performed. Color Doppler ultrasonography was repeated 1 day, 1 month, and 6 months after the operation. The determination of erectile function at a mean follow-up of 41 months (range 17 to 64) was performed using the International Index of Erectile Function.
Postoperatively, color Doppler ultrasonography revealed the absence of recurrence in 6 patients. Fistula recurrence was detected in 4 of 9 patients treated with selective embolization (44%). In three of these patients, a second embolization procedure was conclusive. In 1 case (11%), three consecutive embolizations were not conclusive and surgical ligature of the dorsal artery and collateral at the emergence of the penile root, out of the corpus cavernosum, was required. Sexual function was completely preserved in 80% of patients.
Pudendal angiography with superselective embolization is the treatment of choice. It is well tolerated and ensures a high preservation of premorbid erectile function.
Urology 02/2002; 59(1):110-3. · 2.43 Impact Factor
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ABSTRACT: Our objective was to investigate prevalence and Doppler characteristics of penile cavernosal–spongiosal communications (CSC).
These vessels are either anastomoses connecting the cavernosal arteries with the urethral arterial network or afferent vessels
to the corpus spongiosum. Sixty-one consecutive patients underwent penile color Doppler US. Waveform changes in CSC were evaluated
in comparison with changes in the cavernosal artery. Eighteen of 61 patients had normal erection, 17 of 61 had arterial insufficiency,
and 26 of 61 had veno-occlusive dysfunction. Resistance index (RI) in CSC was significantly lower than in cavernosal arteries
in all patients and increased during phases 1–2 (positive diastolic flow). Peak systolic velocity (PSV) in CSC was significantly
higher in the patients with veno-occlusive dysfunction. During cavernosal phase 4 (diastolic flow reversal) CSC of patients
with normal erection or with arterial insufficiency disappeared, underwent markedly reduced diastolic flow, or had systolic
flow inversion. Conversely, low resistance flow was appreciable in CSC of patients with veno-occlusive dysfunction who reached
phase 4. During phase 5 (systolic peak reduction) all CSC disappeared. Color Doppler US allows evaluation of CSC both in patients
with normal and impaired erection.
European Radiology 08/2001; 12(9):2287-2293. · 3.22 Impact Factor
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ABSTRACT: A number of surgical procedures that significantly change the penile anatomy and vasculature can be used to manage pathologic conditions of the penis (eg, congenital and acquired deformities, erectile dysfunction, priapism). Phallic reconstruction surgery can be used for sex reassignment and after penile amputation or for correction of congenital malformations. Color Doppler ultrasonography (US) clearly depicts the normal penile anatomy and postoperative changes (eg, changes of the tunica albuginea, extraalbugineal pathologic fluid collections, cavernosal tissue changes produced by scars and fibrosis). It is also effective in evaluating surgery-related complications and determining the causes of erectile dysfunction and other unsatisfactory long-term results. Moreover, color Doppler US of the penile vessels and vascular anastomoses following revascularization allows direct evaluation of flow characteristics, shunt patency, and venous engorgement. Color Doppler US is the imaging modality of choice in evaluating patients who have undergone penile surgery.
Radiographics 25(3):731-48. · 2.85 Impact Factor
