Cavernosal arterial anatomic variations and its effect on penile hemodynamic status

Analysis of patient education materials on TikTok for erectile dysfunction treatment

Erectile dysfunction (ED) is widely prevalent and has diverse management options which are poorly understood and accessed by patients. This cross-sectional TikTok study aimed to evaluate the quality of ED educational materials and define trends in healthcare provider content development. Three reviewers independently analyzed 50 videos. Variables of interest included author characteristics, viewer engagement, content accuracy, and video quality, understandability, and actionability. Quantitative analysis was performed using the validated PEMAT and DISCERN screening tools. A wide range of treatment options were presented among the 26 healthcare and 24 non-healthcare videos, including behavioral techniques, herbs/ supplements, dietary modifications, pharmacology, and interventions. Healthcare authors tended to focus on pharmacology and intervention, and when they did discuss behavioral, herbal, or dietary options, accuracy significantly exceeded non-healthcare authors (96.2% vs. 12.5%, p < 0.001). Although healthcare-authored videos were superior in accuracy and understandability scores (p < 0.001), they had low actionability and reduced user engagement including likes (1195 vs. 4723, p = 0.050) and bookmarks (114 vs. 839, p = 0.010). Our findings indicate that despite the availability of high-quality ED treatment resources created by healthcare professionals on TikTok, engagement and actionability remain alarmingly low. Furthermore, there is substantial, readily accessible misinformation produced by non-healthcare entities. Modernized medical education paradigms, communications research, and awareness may optimize social media as a public health tool.

Penile Doppler Ultrasound for Erectile Dysfunction: Technique and Interpretation

OBJECTIVE. Erectile dysfunction (ED) is a common medical condition that has a high prevalence and incidence worldwide and may have a significant impact on both physical and psychosocial health. The purpose of this article is to review the role of penile Doppler sonography in the assessment of ED. CONCLUSION. Penile Doppler sonography is an essential tool for differentiating between vascular and nonvascular causes of ED; therefore, radiologists must be familiar with the imaging protocol, the limitations of the technique, and interpretation of its findings, to warrant an accurate diagnosis and appropriate patient management.

The visceromotor and somatic afferent nerves of the penis

INTRODUCTION

Innervation of the penis supports erectile and sensory functions.

AIM

This article aims to study the efferent autonomic (visceromotor) and afferent somatic (sensory) nervous systems of the penis and to investigate how these systems relate to vascular pathways.

METHODS

Penises obtained from five adult cadavers were studied via computer-assisted anatomic dissection (CAAD).

MAIN OUTCOME MEASURES

The number of autonomic and somatic nerve fibers was compared using the Kruskal-Wallis test.

RESULTS

Proximally, penile innervation was mainly somatic in the extra-albugineal sector and mainly autonomic in the intracavernosal sector. Distally, both sectors were almost exclusively supplied by somatic nerve fibers, except the intrapenile vascular anastomoses that accompanied both somatic and autonomic (nitrergic) fibers. From this point, the neural immunolabeling within perivascular nerve fibers was mixed (somatic labeling and autonomic labeling). Accessory afferent, extra-albugineal pathways supplied the outer layers of the penis.

CONCLUSIONS

There is a major change in the functional type of innervation between the proximal and distal parts of the intracavernosal sector of the penis. In addition to the pelvis and the hilum of the penis, the intrapenile neurovascular routes are the third level where the efferent autonomic (visceromotor) and the afferent somatic (sensory) penile nerve fibers are close. Intrapenile neurovascular pathways define a proximal penile segment, which guarantees erectile rigidity, and a sensory distal segment.

What is the origin of the arterial vascularization of the corpora cavernosa? A computer-assisted anatomic dissection study

The purpose of this study was to identify the microscopic arterial vascularization of the corpora cavernosa (CC) of the penis using computer-assisted anatomic dissection (CAAD), determine the contribution of the different penile arteries towards this vascularization, detail the nature of cavernospongiosum shunts, and locate the anastomoses between these different arteries. Tissue specimens were taken from five donors who donated their bodies to science. The specimens were fixed in 10% formalin and sliced into a series of five 5-μm sections at intervals of 200 μm. The first section was stained with hematoxylin-eosin or Masson's trichrome and the second with anti-protein S100. The cavernous artery of the penis is not the only source of arterial vascularization of the CC. In four of the five cases studied, we found two to four perforating branches arising from the dorsal arteries of the penis that join up with the cavernous artery of the penis or that are solely responsible for the vascularization of the distal third of the penis. The bulbo-urethral and urethral arteries are situated outside of the tunica albuginea of the corpus spongiosum on their lateral and dorsal sides. The anastomoses do not occur between the cavernous artery of the penis and the corpus spongiosum but between the cavernous artery of the penis and the urethral artery on the surface of the tunica albuginea. All of these arteries are accompanied by nerve branches. The CC were found to be vascularized by both cavernous and dorsal arteries of the penis. Intrapenile vascularization is organized around four arterial axes, which are anastomosed by multiple neurovascular shunts.

Corpus cavernosum electromyography: could it be a parameter to predict ageing?

In this study, we investigated whether electromyography of corpus cavernosum (CC-EMG) results vary with age and whether CC-EMG could be a parameter to predict ageing of cavernous smooth muscle. Recordings of electrical activity of corpus cavernosum (EACC) were retrospectively investigated in 134 patients with erectile dysfunction. Penile colour Doppler ultrasonography and cavernosometry were also performed for all of the patients. The total number and duration of EACC and amplitudes between positive and negative peaks were compared between the flask state for 10 min and after intracavernosal papaverine injection. The mean age of the 47 patients in group 1 was 35.2 ± 6.3 years (range, 23-44), the mean age of the 45 patients in group 2 was 51.1 ± 3.1 years (range, 45-56) and the mean age of the 42 patients in group 3 was 61.8 ± 4.6 years (range, 57-77). Total IIEF-5 score was 7.6 ± 2.1 in group 1, 7.9 ± 2.4 in group 2 and 7.9 ± 2.1 in group 3. There were no statistically significant differences among the groups regarding electrical potential frequencies, durations and amplitudes of electromyographic recordings.

CONCLUSION

We do not think that CC-EMG findings could be used efficiently as a predictor of ageing.

Erectile Dysfunction

Erectile dysfunction has been defined by the National Institutes of Health as the inability to achieve and/or to maintain an erection for satisfactory sexual intercourse. It may result from psychological or organic causes. With the advent of oral pharmacotherapy, the diagnostic approach has significantly changed over the past decade. The number of patients examined at the radiology clinics has also been decreased. However, evaluation by imaging modalities, such as color Doppler ultrasound, cavernosography, and angiography, still remains the cornerstone of the diagnostic workup of the patients with erectile dysfunction. The aim of this review was to focus briefly on the penile anatomy, the pathophysiology of erection, and radiological techniques for investigating vascular causes of erectile dysfunction and findings on different radiological methods.

Anatomic variations of cavernous arteries and their effect on measurement of hemodynamic parameters: a power Doppler study

OBJECTIVES

To assess the cavernous arterial (CA) anatomy with power Doppler imaging and evaluate the effects of any anatomic variations on the measurement of hemodynamic parameters.

METHODS

Thirty-three patients with and 26 without a vascular component to their erectile dysfunction were examined. The CA anatomy was evaluated, and hemodynamic variables were measured at multiple sites, including sites in each artery, if multiple CAs were present.

RESULTS

The frequency of anatomic variation was similar between the two groups. A single CA, considered normal, was observed in 57.7% of 52 corpora in the nonvasculogenic group and in 63.6% of 66 corpora in the vasculogenic group. Seven patients (26.9%) in the nonvasculogenic group and 11 (33.3%) in the vasculogenic group had CA anatomy that was different between the right and left corpora. In both groups, a single CA ordinarily showed at least a 35.0% decrement in the mean peak systolic velocity (PSV) between the crura and the proximal shaft; double, triple, and bifurcated CAs also had distally decreased PSV. However, two corpora with a single CA showed an increased PSV distally; in 1 patient, arterial communication between the corpora was responsible. In 86.7% of corpora with double CAs in the vasculogenic group and in 52.6% in the nonvasculogenic group, the CA distant from the crura showed a greater PSV than that near the crura.

CONCLUSIONS

CA anatomy is variable, and the PSV differs between sites, irrespective of the presence of a vascular component to erectile dysfunction. Thus, anatomic variations should be considered when interpreting Doppler sonography.