Physiological interrelationships between the venous shunts of penile corpus spongiosum and cavernous compartments during erection used in the pharmacotherapy of erectile dysfunction.

Abstract

AIM OF THE STUDY: Alprostadil (A) induces smooth-muscle relaxation by stimulating the increasing of intracellular cAMP. Intra-urethral administration is an alternative to its intra-cavernose injection in inducing erection. In order to understand the functional and anatomical basis for drug transfer, the possible communications of the corpus spongiosum with the corpora cavernosa were studied.

MATERIAL OF STUDY: A “Spongiogram” (SP) was performed in 44patients (pt.) by injection of radiological contrast into the glans. The SP visualized drainage of the glans into the deep dorsal vein, as well as that of the spongiosum into the circumflex veins, which in turn drained into the deep dorsal vein.

RESULTS: In 34pt. (77,2%) filling of the corpora was also visualized; in 10pt.(22.8%), with ectasia of the deep dorsal vein, such a filling was not visualized.

DISCUSSION: Filling of the corpora cavernosa, in 34 pt. demonstrated the presence of “spongiosal-cavernosal” shunts.

CONCLUSIONS: The presence of “spongiosal-cavernosal” shunts justified the efficacy of A in term of complete penile erection, regarding also corpora cavernosa; in the other cases an increased speed of venous discharge justified the drug’s lack of local efficacy, with poor results in terms of erection.