Hemodynamics of penile erection

• Erection and detumescence are hemodynamic events regulated by relaxation and erection of the corporal smooth muscles

Flaccid state of penis

Erect state of penis (veno-occlusive mechanism)

Innervation of penis

Relations of cavernous nerves to urethra are as follow:

Posterolateral to apex of prostate (5 & 7 o’clock).

Lateral to membranous urethra (3 & 9 o’clock).

Anterior to bulbar urethra (1 & 11 o’clock) where it enter the hilum of penis.

Arterial supply of penis

Venous drainage of penis

Ejaculation

• Efferent signals traveling in hypogastric nerve activate secretions and transport sperm from the distal epididymis, vasa deferentia, seminal vesicles, and prostate to the prostatic urethra.

Ejaculation

• Coordinated closing of the internal urethral sphincter, relaxation of the external sphincter and rhythmic contractions of the bulbospongiosus muscles direct the semen into the bulbous urethra (emission).

Sexual dysfunction following TURP

Incidence of sexual dysfunction:

• Retrograde ejaculation is an established compliaction of TURP (upto 83%).

• Effect on other aspects of erectile function is still controversial (range from 5-13%).

(Munteuer et al., 2006)

Risk factors for ED after TURP

• Risk factors for sexual dysfunction include:

Capsular perforation adjacent to neurovascular bundle at the prostatic apex.

Small adenoma.

D.M.

(Munteuer et al., 2006)

ED after PKVP (plasma kinetic vaporization of prostate)

• Incidence: 10.6%

• Risk factors for sexual dysfunction include:

Capsular perforation.

D.M.

(Xiao yong et al., 2006)

Sexual Health Inventory for men (SHIM)

SHIM score

• Total score ranges from 5 to 25 based on the 5 questions.

• Each point is rated on likert score of:

1= least functional; …….; 5= most functional.

(Prost and Buvat, 2006)

SHIM score

• The score characterizes ED severity as follows:

22 – 25 = normal EF.

17 – 21 = mild ED.

12 – 16 = mild to moderate ED.

8 – 11 = moderate ED.

< 7 = severe ED.

(Prost and Buvat, 2006)