Metz P
Dan Med Bull. 1986 Jun;33(3):134-50.
Organic causes of erectile impotence, including penile arterial insufficiency, is far more frequent than previously assumed. The aim of this review (based on the literature and previous works of the author) is to define arteriogenic erectile impotence, and to describe its pathophysiological and clinical features, the diagnostic approach, differential diagnostic aspects and possible treatment of this type of impotence. Erectile impotence is inability to react to relevant sexual stimulation, with a change in pelvic and penile hemodynamics that will increase the pressure in the cavernous bodies thus enabling vaginal intromission without special precautions; as well as inability to maintain this pressure ordinarily until ejaculation occurs. Arteriogenic erectile impotence is erectile impotence caused by insufficient arterial blood supply to the cavernous bodies regardless of the arterial disease or abnormality responsible for the insufficiency. The normal mechanism of erection is not fully understood. Accumulation of blood under pressure in the cavernous body is brought about by dilation of the arteries to the cavernous spaces and closure of the drainage from the cavernous body. The drainage blockade is active and located just inside the tunica albuginea at the origin of the emissary veins. The mechanism is probably related to the smooth muscles of the cavernous body which become relaxed at the start of erection. Furthermore, passive out-flow restriction probably supporting the active closure when the cavernous body is distended. The autonomic nerves regulating the erection come from Th10-L2 and S2-S4 and pass the pelvic plexus. The target organ neurotransmitters are probably vasoactive intestinal polypeptide and catecholamines. Penile arterial insufficiency can be demonstrated by penile blood pressure measurement either as a simple measurement, or, better, as pelvic steal test and hyperemic stress test. Ultrasonic Doppler pulse curve analysis is another way of demonstrating penile arterial insufficiency. Visualization of the arterial disease causing penile arterial insufficiency requires bilateral selective internal iliac arteriography.(ABSTRACT TRUNCATED AT 400 WORDS)
器质性勃起功能障碍的病因，包括阴茎动脉供血不足，远比之前认为的更为常见。本综述（基于文献及作者之前的研究）旨在明确动脉源性勃起功能障碍，描述其病理生理及临床特征、诊断方法、鉴别诊断要点以及此类功能障碍的可能治疗方法。勃起功能障碍是指无法对相关性刺激产生反应，伴有盆腔和阴茎血流动力学改变，从而在无需特殊措施的情况下增加海绵体内压力以实现阴道插入；以及无法正常维持该压力直至射精。动脉源性勃起功能障碍是指无论导致供血不足的动脉疾病或异常情况如何，因海绵体动脉血供不足引起的勃起功能障碍。勃起的正常机制尚未完全明了。海绵体内压力下血液的积聚是由海绵体动脉扩张及海绵体引流关闭所致。引流阻塞是主动的，位于白膜内导静脉起始处。其机制可能与勃起开始时海绵体平滑肌松弛有关。此外，当海绵体扩张时，被动流出受限可能支持主动关闭。调节勃起的自主神经来自胸10至腰2及骶2至骶4，并通过盆腔丛。靶器官神经递质可能是血管活性肠肽和儿茶酚胺。阴茎动脉供血不足可通过阴茎血压测量来证实，可采用简单测量方法，或者更好的是采用盆腔窃血试验和充血应激试验。超声多普勒脉冲曲线分析是另一种证实阴茎动脉供血不足的方法。导致阴茎动脉供血不足的动脉疾病的可视化需要双侧选择性髂内动脉造影。（摘要截选至400字）
