High-flow priapism and glans hypervascularization following deep dorsal vein arterialization for vasculogenic impotence.

Microsurgical penile revascularization is becoming an increasingly applied technique in patients with arteriogenic or mixed arteriogenic and venogenic impotence. Deep dorsal vein arterialization has been used successfully in selected patients. Aside from failure of the procedure and the occasional problems associated with vascular surgery, priapism and glans hypervascularization are specific complications of deep dorsal vein arterialization. Priapism in these cases is 'high-flow'; the functional arterial-cavernous fistula can overcome the maintenance of the flaccid state and cause persistent erection. Glans hypervascularization, a syndrome of glans enlargement, skin changes and pain secondary to excessive retrograde filling of the glans penis and corpus spongiosum, can result in urethral compression and glans ulceration. Along with the presentation of the case of a man who suffered both complications, we discuss their pathophysiology, prevention, and treatment.     

Deep dorsal vein arterialization in pure cavernoocclusive dysfunction

PURPOSE: We report our 4-year experience with deep dorsal vein arterialization at 3 years' follow-up in young patients with pure cavernoocclusive dysfunction as an alternative to penile prosthesis implantation. MATERIALS AND METHODS: We performed a modified Furlow-Fisher operation (circumflex collaterals are preserved and the deep dorsal venous valves are not disrupted by a stipper) in 25 patients who did not have risk factors such as general arteriosclerosis, coronary heart disease, hypertension, hyperlipidemia and age (over 40 years). Patients with arterial disease diagnosed by Doppler examination were excluded from the study. Also, patients with abnormal penile biothesiometric and electromyographic findings were not included in the study. Beside the subjective and objective evaluation the efficacy of the operation was also assessed retrospectively in 18 patients by telephone according to items 3 (ability to achieve an erection) and 4 (ability to maintain an erection) of the 15-item International Index of Erectile Function (IIEF). RESULTS: With a mean follow-up of 28 months (range 4-42) subjective and objective success rates were 80 and 72% at 1 year's 75 and 62.5% at 2 years', and 70 and 60% at 3 years' follow-up. According to items 3 and 4 of the 15 item IIEF questionnaire the mean postoperative scores reached 1.55-3.44 and 1. 33-3.27 for items 3 and 4, respectively (p<0.01). Two patients (8%) showed signs of glans hypervascularization as a major complication and minor complications such as penile skin edema, subdermal hematoma, loss of penile skin sensation and early thrombosis of the anastomosis were found in a total of 8 patients (32%). CONCLUSIONS: Deep dorsal vein arterialization is a preferable choice in highly selected young patients as an alternative to penile prosthesis.     

Evaluation of male sexual function by the International Index of Erectile Function after deep dorsal vein arterialization of the penis.

PURPOSE: The objective of vascular surgery for erectile dysfunction is to provide long-term improvement of erectile function. We evaluated that claim after deep dorsal vein arterialization by a cross-sectional study of multifaceted male sexual function with the validated International Index of Erectile Function (IIEF). MATERIALS AND METHODS: We performed a mail survey of male sexual function after deep dorsal vein arterialization in 68 consecutive literate men who underwent surgery between 1984 and 1998 for severe erectile dysfunction. The IIEF questionnaire and a questionnaire on patient characteristics were answered in a self-administered and nominative manner. Scores of the responders pertaining to the 5 domains of male sexuality were compared with those of the control groups used for the psychometric validation of the IIEF. RESULTS: Of the patients 38 (55.9%) with a mean age plus or minus standard deviation of 46.5 +/- 11.9 years responded. Mean followup was 61.2 +/- 34.7 months. Compared to controls with erectile dysfunction controls men who underwent deep dorsal vein penile arterialization had significantly higher scores for erectile function, sexual desire, orgasmic function, intercourse satisfaction and overall satisfaction. Conversely compared with normal controls these patients reported significantly lower erectile function, orgasmic function, intercourse satisfaction and overall satisfaction scores, whereas sexual desire scores were similar in the 2 groups. No correlations were noted of the 5 IIEF domains with the duration of followup after arterialization. When erectile function scores were graded, 25.0% and 28.1% of patients reported no and or mild dysfunction, respectively, while 15.6% still complained of severe erectile dysfunction. CONCLUSIONS: Long-term improvement in the various aspects of male sexual function was observed after deep dorsal vein penile arterialization in a significant proportion of patients.     

Hypervascularity of the glans penis following arterialization of the dorsal vein.

A variety of new treatments are available for impotent men who wish to avoid a prosthesis. Arterialization of the deep dorsal vein of the penis is one of the new surgical procedures used in the treatment of men who do not respond to pharmacological agents due to vasculogenic impotence. Hypervascularity of the glans penis is a potential complication of this procedure and usually occurs during the early postoperative period. We present a patient with delayed onset of hypervascularity of the glans penis, and discuss the prevention and management of this complication.     

Penile deep dorsal vein cushions and erection

During surgical treatment of impotence due to venous leakage, the deep dorsal veins from 10 patients were resected and studied histologically to see if any morphological anomaly could be implicated in the physiopathological mechanism of venous leakage. Normal venous cushions were present in these veins similar to those observed in the deep dorsal veins of patients with normal erections. Their function and possible deterioration are discussed.     

阴茎背深静脉的局部解剖

目的：研究阴茎背深静脉(DDV)的局部解剖，为相关疾病的诊断和治疗提供帮助。方法：对死亡原因和生前阴茎勃起状况不明的14具甲醛处理的成年男性尸体DDV进行解剖，记录和描述DDv各段属支数目走行特点。结果：14具标本中7具为双干。共有21支DDV；在8个标本。共有9支DDV进入一侧阴部内静脉；7个标本在固定段有属支。共9支；在悬垂段。中间属支成丛状在中间沟内注入DDV的海绵体侧。结论：解剖发现了一些与临床诊断和手术治疗密切相关的因素，在研究和临床工作中应该适当重视。     

Electromyographic changes after carpal tunnel release

This prospective clinical study was designed to quantitate post-carpal tunnel release electromyographic (EMG) changes in the median nerve, and changes in static two-point discrimination, pinch strength, and grip strength. Carpal tunnel release was performed in 54 hands of 36 patients (average age of patients was 44.6 years). The EMG and clinical studies were completed just before surgery, at 2 weeks, and then at postoperative periods of 3, 6, 9, 12, 18, and 24 months. The sensory latencies and motor latencies were significantly (p less than 0.05) improved at the 3- and 6-month postoperative periods, respectively. The motor and sensory conduction velocities were significantly (p less than 0.05) improved as early as 2 weeks postoperatively. Two-point discrimination values were significantly (p less than 0.05) improved at 2 weeks postoperatively. For the pinch and grip strengths, significant (p less than 0.05) improvement did not occur until the 6- and 9-month postoperative periods, respectively. These results should be of considerable value, especially in the evaluation of the post-carpal tunnel release patient with persistent or recurrent symptoms.     

Post-traumatic ophthalmic vein arterialization.

An unusual case of post-traumatic exophthalmos without pulsation, bruit or thrill, due to missile injury is presented. Arterialization of the ophthalmic vein represents one of the very few situations where an eye injury can lead to exsanguination and dealth unless the diagnosis is made early. Prompt carotid arteriography is advised to document the pathologic process and guide appropriate therapy.     

Venous surgery in veno-occlusive dysfunction: long-time results after deep dorsal vein resection.

Follow-up of patients 1 year after deep dorsal vein resection gives evidence of an approximate 50-60% success rate. A careful selection of only this small percentage of patients, in whom abnormal drainage through the penile dorsum is obvious, is mandatory. Men with an arterial cofactor have to be excluded or to be subsequently treated by intracavernosal autoinjection of vasoactive substances. Late results from our study demonstrate a further loss of sufficient erection, also in men considered as persistent success by us, in the subjective view of the patient and/or his sexual partner.     

扩大肝部分切除术后入肝门静脉动脉化对大鼠血流动力学的影响

目的对大鼠行扩大肝部分切除术后利用右肾动脉行入肝门静脉动脉化加门腔分流术,研究该术式对大鼠门静脉血流动力学的影响。方法 Sprague-Dawley大鼠130只,分为A组(动脉化组)47只,行70%扩大肝部分切除术后,用右肾动脉行门静脉动脉化加门腔分流术;B组(肝切组)43只,行70%扩大肝部分切除及右肾切除,阻断门静脉10min;C组(对照组)40只,仅行右肾切除及门静脉主干游离。分别于术后第2、7、14、28天检测门静脉压力、内径和血流量。结果 A组及B组手术成功率分别为85.1%和93.0%,差异无统计学意义,C组手术成功率100%。术后各时间点A组与B、C组比较,入肝门静脉压力、门静脉内径、血流速度和入肝血流量变化均较后两组更明显(P0.01);A组入肝门静脉压力随时间推移有下降趋势,于术后第14天(12.7±0.7)cmH2O达到稳态,与术后第28天(12.4±0.6)cmH2O比较,差异无统计学意义;而A组门静脉内径、血流速度和入肝血流量在术后各时间点间相比差异无统计学意义。B组术后门静脉血流速度均较C组增快(P0.05),门静脉血流量在术后14～28d较C组增加(P0.05)。结论大鼠扩大肝部分切除术后行入肝门静脉动脉化模型稳定可靠,手术成功率理想,动脉化术后门静脉压力明显升高,门静脉内径出现扩张以适应压力变化,入肝血流量明显增加。门静脉血流动力学指标在术后早期即发生改变并取得稳态。     

门静脉动脉化在肝脏外科的应用

门静脉动脉化是一种为防止肝脏缺血导致的肝损害而将动脉血灌注入门静脉的方法.本文就其在肝移植、肝门部肿瘤和门脉高压症外科治疗、急性肝功能衰竭治疗中的临床应用情况及存在的问题做一综述.     

Arterialization of deep dorsal vein of penis for penile ischemia

Penile ischemia, a rare complication of diabetic end-stage renal disease, is usually treated by penectomy once conservative measures fail. We present a patient with diabetes mellitus and end-stage renal disease with penile ischemia that was successfully treated with an arteriovenous interposition bypass graft between the common femoral artery and the deep dorsal vein of the penis. Retrograde flow into the corpus spongiosum resulted in immediate pain relief and healing of the ischemic lesions.     

Results of deep dorsal vein ligation for venogenic impotence]

We treated seventy venogenic impotence with ligation of the deep dorsal vein of the penis. Their corporal veno-occlusive function was evaluated by dynamic infusion cavernosometry and cavernosography (DICC). Under local anesthesia, we made a longitudinal skin incision at the base of the penis. The deep dorsal vein was ligated and also a portion of this vein of 1.5 cm long was resected together with branches surrounding the vein. After the operation, the infusion rate determined by DICC was confirmed to be decreased in almost all patients. Thirty nine out of seventy cases had their erectile capability restored and reported that they could achieve sexual intercourse. Sixty one of the seventy cases showed full erection together with an intracavernous papaverine injection. However fifty percent of the sixty one patients who became capable of obtaining erection with the treatment had lost their erectile capability again within one year of the operation, however the other fifty percent were shown to maintain their erectile capability for up to three years. As four years after the treatment only thirty percent of those who had achieved the initial erectile capability still remained potent. This operation is easy to perform without any major complications, and its outcome is as good as that achieved by other more invasive venous ligation in the treatment of patients with venogenic impotence. We therefore conclude that penile deep dorsal vein ligation and partial resection of the vein one of the most useful treatments currently available for venogenic impotence and should be the treatment of choice.     

Contractile response of horse deep dorsal penile vein to histamine

The present investigation was designed to evaluate the effect of histamine on isolated rings of horse deep dorsal penile vein. Under precontracted or basal conditions, histamine evoked an endothelium-independent contraction. Preincubation of the vein rings with the selective H1 receptor antagonist, mepyramine, shifted the concentration-response curve for histamine and to the H1 receptor agonist 2-pyridylethylamine to the right in a competitive manner. Pretreatment with cimetidine, a specific H2 receptor antagonist, did not modify the pEC50 and maximal contraction of the histamine response. Cimetidine and propranolol failed to induce a change in the relaxation caused by dimaprit, the H2 receptor agonist. Histamine contraction was unaffected by thioperamide, the specific H3 receptor antagonist. (R)-alpha-methylhistamine, the H3 receptor agonist, also induced contractions which persisted in the presence of either thioperamide or tetrodotoxin. These data indicate that horse deep dorsal penile vein shows an endothelium-independent contraction response to histamine, mainly mediated by H1 receptors.     

门静脉动脉化的临床应用

门静脉动脉化是一种为防止肝动脉血流阻断后的肝损害而将动脉血流导入门静脉的方法。其在肝硬化门静脉高压症门体分流术、肝移植、进展期肝胆恶性肿瘤等手术中有一定的适用范围。本文就其临床应用情况做一综述，并初步总结了这一技术在临床应用中存在的问题。     

A review of percutaneous deep vein arterialization for the treatment of nonreconstructable chronic limb threatening ischemia

Peripheral arterial disease is estimated to affect more than 200 million people worldwide with some patients progressing to chronic limb threatening ischemia (CLTI). Patients with CLTI have extremely high rates of amputation and associated increases in morbidity and mortality. There is a subset of patients with CLTI that have no available options for revascularization due to factors such as the absence of distal target vessels or adequate conduit for surgical revascularization. Percutaneous deep vein arterialization can be used in patients with nonreconstructable CLTI. In this review article, we discuss patient selection, methods, and techniques of deep vein arterialization. In addition, results from studies evaluating the use of percutaneous deep vein arterialization, such as the Alkmaar (The Netherlands), Leipzig (Germany), Paris (France), and Singapore (ALPS) multicenter center study and the prospective, multicenter, single-arm, early feasibility (PROMISE I) trial, are highlighted. These results have been encouraging with improved rates of limb salvage and wound healing reported, suggesting percutaneous deep vein arterialization may be beneficial in treating patients with CLTI.     

Incidence of deep vein thrombosis after varicose vein surgery

BACKGROUND: Varicose vein surgery is generally considered to have little risk of postoperative deep vein thrombosis (DVT). This prospective study examined the incidence of DVT in patients undergoing varicose vein surgery. METHODS: Lower leg veins were assessed before operation by duplex ultrasonography in 377 patients, and reassessed 2-4 weeks after surgery, and again at 6 and 12 months. Patients were instructed to contact a physician if symptoms consistent with DVT occurred before the scheduled follow-up appointment. Preoperative prophylaxis (a single dose of subcutaneous heparin) was left to the discretion of the vascular surgeon. RESULTS: DVT was detected in 20 (5.3 per cent) of the 377 patients. Of these, only eight were symptomatic and no patient developed symptoms consistent with pulmonary embolus. Eighteen of the 20 DVTs were confined to the calf veins. Subcutaneous heparin did not alter the outcome. No propagation of thrombus was observed and half of the DVTs had resolved without deep venous reflux at 1 year. CONCLUSION: The incidence of DVT following varicose vein surgery was higher than previously thought, but these DVTs had minimal short- or long-term clinical significance.     

Long-term results of deep dorsal penile vein transsection in venous impotence

29 individuals with venous impotence underwent transsection of the deep dorsal penile vein, of the superficial and ectopic veins, if any. 19 patients responded initially with either spontaneous erections or increased sensitivity of the cavernous bodies to intracorporeal papaverine. 1 patient developed postoperative priapism. The majority of patients who failed to respond had major leakage into the cavernous veins or abnormal connections between the spongious and cavernous bodies. An intraoperative decrease of flow rates to induce and maintain erection was found to be indicative for response. 10 individuals developed secondary erectile dysfunction 4-24 months after the initial response. A more extensive surgical approach should be considered to improve long-term success rates.     

Histopathological alterations of deep dorsal penile vein in venogenic impotence.

The mechanism and hemodynamics of penile veins in erection have long been a matter of controversy and hypotheses. With the intention to develop a new concept of venous ultrastructure in penile venous insufficiency, we studied the histopathology of 13 dorsal penile veins obtained from important patients during venous ligation because of proven venous leakage. Besides, 1 normal deep dorsal vein taken from a volunteer who underwent another type of penile operation was also examined. All sections were stained with hematoxylineosin, Gomori trichrome, periodic acid-Schiff, Gomori reticulum and Verhoeff elastic stains. All 13 veins showed some significant histological changes namely nodular hypertrophy in 7, nodular atrophy in 2, diffuse atrophy in 2, diffuse hypertrophy in 1 and minimal changes in 1. In general, the dominating histological appearance was hypertrophy of the muscular pattern and enhancement of collagenization. None of these alterations was prevalent in the normal control. The cause and the result relationship between venous leakage and the mentioned histological changes still remains a matter of debate.