Kawanishi Yasuo, Miyake Takeshi, Yamanaka Masahito
Department of Urology, Takamatsu Red Cross Hospital, Takamatsu, Kagawa, Japan.
Arab J Urol. 2024 Mar 23;22(4):212-218. doi: 10.1080/20905998.2024.2333675. eCollection 2024.
Chronic ischemia-related cavernous dysfunction is considered irreversible. However, in certain patients, cavernous function appears to recover with penile revascularization. In this study, we investigated a potential cavernous dysfunction reversibility from a clinical perspective.
We involved 93 young patients in the study with arterial erectile dysfunction (ED) (median age: 30 years). Erectile function tests were performed according to the standard operating procedures of the International Society of Sexual Medicine. Among the participants, 63 and 30 displayed pure arteriogenic and mixed vasculogenic (due to both arterial insufficiency and cavernous dysfunction) ED, respectively. Penile revascularization was performed by anastomosing the inferior epigastric artery to the dorsal artery. The ED treatment success was considered from a score of at least 24 on the International Index of Erectile Function-6.
Our results proved that penile revascularization cured 92.1% and 73.8% of the patients with pure arteriogenic and mixed vasculogenic ED, respectively (Kaplan-Meier method, log-rank test: no significant difference). The required time for curing 50% of the patients was 10.5 and 10.0 months for pure arteriogenic and mixed vasculogenic ED, respectively, indicating no recovery delay in patients with mixed vascular ED. Furthermore, the cavernous dysfunction degree did not influence cavernous function recovery.
Penile revascularization cured ED in 73.8% of the patients with mixed vasculogenic ED. Cavernous dysfunction appears to be reversible in certain cases. Furthermore, we observed no delay in functional recovery compared to participants with healthy cavernous function. These two discoveries suggest that cavernous function recovery after penile revascularization is similar to the concept of hibernating myocardium in ischemic myocardium. Although cavernous dysfunction is considered irreversible, it could be reversed in multiple cases with blood flow restoration to the cavernous tissue.
慢性缺血相关的海绵体功能障碍被认为是不可逆的。然而，在某些患者中，阴茎血运重建后海绵体功能似乎会恢复。在本研究中，我们从临床角度探讨了海绵体功能障碍潜在的可逆性。
我们纳入了93名患有动脉性勃起功能障碍（ED）的年轻患者（中位年龄：30岁）。勃起功能测试按照国际性医学学会的标准操作程序进行。在参与者中，分别有63例和30例表现为单纯动脉源性和混合性血管源性（由于动脉供血不足和海绵体功能障碍）ED。通过将腹壁下动脉与背动脉吻合进行阴茎血运重建。勃起功能障碍治疗成功的标准是国际勃起功能指数-6得分至少为24分。
我们的结果证明，阴茎血运重建分别治愈了92.1%的单纯动脉源性ED患者和73.8%的混合性血管源性ED患者（Kaplan-Meier法，对数秩检验：无显著差异）。治愈50%患者所需时间，单纯动脉源性ED为10.5个月，混合性血管源性ED为10.0个月，这表明混合性血管性ED患者的恢复没有延迟。此外，海绵体功能障碍程度不影响海绵体功能恢复。
阴茎血运重建治愈了73.8%的混合性血管源性ED患者。在某些情况下，海绵体功能障碍似乎是可逆的。此外，与海绵体功能正常的参与者相比，我们未观察到功能恢复延迟。这两个发现表明，阴茎血运重建后的海绵体功能恢复类似于缺血心肌中的冬眠心肌概念。虽然海绵体功能障碍被认为是不可逆的，但在许多情况下，随着海绵体组织血流的恢复，它可能会逆转。
