Czechoslovak contribution to current concepts in impotence, its pathogenesis, diagnosis and treatment.

Czechoslovak contribution to the current concepts in impotence, its pathogenesis, diagnosis and treatment, consists especially in: the recognition of the haemodynamics of erection. The process involves two stages; in the first one, the arterial bed must deliver to the corpora cavernosa (CC) threshold values of volume and pressure needed for filling and distention of the CC, in the second period, the CC function as a closed system on the hydraulic principle, and contractions of the ischiocavernous muscles increase intracavernous pressure to suprasystolic values, the observation that it is just failure of the haemodynamics of erection that plays an important role in the pathogenesis of impotence in a majority of patients. The development of artificial erection into a real functional examination of the CC enables to differentiate: disorders with normal haemodynamics of erection, those due to insufficient arterial supply, insufficient blockage of venous return, or insufficient and ineffective contractions of the ischiocavernous muscles. the development of the phalloarteriographic technique which allows a precise anatomical diagnosis of the lesions in the afferent arterial bed, providing the basis for the development and indication of a number of reconstructive procedures in the arterial bed supplying the CC. In addition, the examination has also helped to clarify the relationship between erectile disorders, arterial disease and their risk factors. In retrospect, Czechoslovak research into impotence has substantially contributed to the recognition of vasculogenic impotence, to the therapy of arteriogenic erectile disorders and to a basic change in the concepts of the aetiology and pathogenesis of impotence.