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Page 26
May 24-25, 2018
London, UK
Vascular Surgery 2018
3
rd
Edition of World Congress & Exhibition on
Vascular Surgery
Journal of Vascular and Endovascular Therapy
ISSN: 2573-4482
E
rectile dysfunction (ED) concomitant with psychosis is
common in adults younger than 30 years. Most cases are
con-sidered entirely psychogenic in nature. Given that penile
erection-related veins constitute the principal components in
erectile rigidity in defrosted cadaveric he-modynamic studies; do
venogenic factors dominate psychogenic factors in males with
ED? Although phospho-di-esteraser-5 inhibitors have clarified
current ED medi-cal treatment, resulting in a consensus on ED
pathophysiology, the understanding of the erection process
may yet be just at a fledgling stage. Clinically, the psychologi-
cal factor plays a significant role because placebo effect affects
approximately 40% of participants in clinical trials. Based on a
novel penile venous anatomy and physio-logical osmolality and
viscosity, an apa-gogical hemodynamic study was conduct-
ed on defrosted cadavers. Implying penile veins themselves
are the most crucial fac-tors in erection physiology and that
obvi-ously venogenic factors are inappropriately considered
cavernosal factor in the list of ED contributors. According to
our vast clinical experience, the penile venous stripping method
proves to be an exclusive and naturally viable treatment option.
The term young ED refers to males with ED who is younger
than 40 years, whereas it strictly referred to males younger
than 30 years in the three publications in our evi-dence based
report. Those young ED males account for 10.3% (35/341) to
14.3% (5/35) (average, 12.1%) of the total patients with ED
who underwent penile venous stripping. Erectile function is the
seamless interplay of psychological and physiological health in
adult males. Penile erection related veins play a principal role in
erectile rigidity in cadaveric hemody-namic studies, and veno-
occlusive dys-function is prevalent in males with ED. However,
psychological factors contribute some extent in ED and they
should not be ignored during ED treatment. The role of the
contribution also cannot be underesti-mated in impotence in
males younger than 30 years.
Figure 1:
Excessive penile veins in impo-tent male younger than 30 years.
(A) In this 29-year-oldman, a 30°, oblique-view cavernosogramdiscloses ex-
traordinary excessive penile veins which ought to be the cause of primary
impotence. The first set of dual cavernosogram (anteri-or−posterior view) is
obtained while a 10-ml diluted iohexol solution is intracavern-ously injected
via a 19 G scalp needle. The preprostatic plexus shows immediately with the
contrast medium. Rapid filling of the internal pudendal and then to internal
iliac veins. Implies the drainage veins of the cavernosal sinusoids is tremen-
dously speedy. (B) An oblique view of the phar-macocavernosogram docu-
ments the veno-occlusive dysfunction despite a rigid erec-tion ensues. The
prostaglandin E1 is in-tracavernously injected via the same needle. (C) In
this 30-year-old male, similar to the panel A, the preprostatic plexus demon-
strates immediately after a 10-ml diluted iohexol solution is injected. Thus
the extraordinary complex veins are com-mensurate with drainage speed.
(D) A veno-occlusive dysfunction was docu-mented because venous chan-
nel exited de-spite rigid erection.
Venous insufficiency is the pivotal contributor in erectile
dysfunction in males younger than 30 years
Geng Long Hsu
1,2
1
Hsu’s Andrology, Taiwan
2
National Taiwan University, Taiwan
Geng Long Hsu et al., J Vasc Endovasc Therapy 2018, Volume 3
DOI: 10.21767/2573-4482-C1-002