Correlati̇on of cli̇ni̇cal and radi̇ologi̇cal parameters wi̇th the effi̇cacy of peni̇le revasculari̇zati̇on surgery i̇n pati̇ents wi̇th erecti̇le dysfuncti̇on

Aim: The aim of this study is to specify the correlation and effectiveness of penile revascularisation operation applied at surgical therapy of erectile dysfunction with clinical and radiological methods. Material And Method: In total 35 patient participated to our study between the dates of 1 January 2012 and 1 July 2014; patients came us with erectile dysfunction complaints and they were deemed suitable for penile revascularisation operation as a result of designating organic origin erectile dysfunction in the light of the examinations. IIEF-5 and IIEF-15 used in order to research erectile dysfunction degree at the preoperative period. Moreover, their fasting glucose, lipid profile, complete blood cell account, testosterone level, prolactin levels were assessed; in addition to this, their blood pressure levels and body mass indexes were tested. As preoperative; penile coloured doppler ultrasonography, cavernosometry and corpus cavernosum electromyography (KK-EMG) preoperatively were done to the whole patients. Besides, coloured Doppler ultrasonography was made aimed at bilateral inferior epigastric arteries at the preoperative period. Both penile coloured doppler ultrasonography was made and inferior epigastric artery and anatomosis areas were reassessed with coloured doppler ultrasonography and the exchange ratios of resistivity indexes and pulsatility indexes were calculated at the postoperative period. Moreover, BT angiography and anastomosis and deep dorsal vein were tried to be monitored. Patients whose anostomosis and deep dorsal vein were manage to monitored and not, were reassessed with their IIEF-5/15 scores and the relation between them tried to be revealed. Findings: The age average of the patients participated to the study were designated as 47,7±13,26 (23-69). Patients were divided into three groups according to their ages as 20-39 (10 people), 40-59 (17 people) and above the age of 60 (8). Those findings were confirmed on patients: 31.4%had diabetes, 31.3% had hypertension, 45.6% were smoker, 17.1% had hyperlipidemia, 22.7% had cardiac medical history, 25.6% were obese. According to penile coloured doppler ultrasonography findings; 22.4% arterial insufficiency, 28% venous stasis, 16.8%arterial and venous stasis were observed in tandem. Peak systolic values under 25 cm/s was assessed as arterial insufficiency and end diastolic values over 5 cm/s was assessed as venous stasis at penile coloured doppler ultrasonography. Flow velocities and pressure decrease ratios that created erection at cavernosometry were calculated and patients with middle or high level of venous leaking were deemed suitable for operation and patients with mild level of vanpus stasis were deemed suitable for medical theraphy. When PRUD and cavernosometrt findings compared, cavernosometry insufficiency and venous stasis were confirmed on 50% of the patients (9 patient out of 18) who had got normal end diastolic flow rate at penile coloured doppler ultrasonography. Consequently, in our study it is confirmed that cavernosometry is more sensitive than penile coloured doppler ultrasonography while identifying venous stasis. At the preoperative period, epigastric arteries were evaluated by coloured doppler ultrasonography and it is aimed to do anostomosis from where the current flow and vein diameter are better. Moreover, it was examined that whether those who had had got abdominal or pelvic operation history, had epigastric arteries intact or not. According to their IIEF scores, it was observed that 2.8% of the patients had got mild ED, 14.2% had got medium light ED, 25.6% had got moderate ED and 57% had got severe ED. On ten patient out of thirty five that we had operated, had got arterial insufficiency, eighteen of them had got venous stasis and seven of them arterial and venous stasis in tandem. At preoperative and postoperative period, coloured doppler ultrasonography aimed at epigastric artery and resistivity and pulsatility indexes with penile coloured doppler ultrasonography were calculated. Some meaningful increases designated statistically at postoperative period on cavernosal artery and epigastric artery resistivity index. On coloured doppler ultrasonography aimed at epigastric artery done at the postoperative third month, it was wholesomely monitored until inderior epigastric artery anostomosis on 32 patients out of 35. No significant change seen on flow velocity and vein diameters. It was possible to see deep dorsal vein with PRDU. Epigastric artery observed as thrombosis on three patient. All three of these patients were over 60 years and diabetic patients drew attention. All the patients had had BT angiography at the postoperative third month. 10 minutes before the operation 60 mg papaverin was given to patients. On 25 patients that had had BT angiography, external iliac artery, inferior epigastric artery, anastomose area and deep dorsal vein had been observed and moreover increased blood flow at cavernosal sinusoids were also monitored. The abovementioned situation couldn't be monitored on 10 other patients. All the patients were evaluated with their IIEF 5-15 scores according to preoperatively and postoperatively and it was determined that the increase ratios of IIEF 5-15 scores of patients whose anastomosis space and deep dorsal vein could be followed-up were prominently high as compared to patients whose anastomosis space and deep dorsal vein couldn't be followed-up. It was determined that this increase was more prominent especially on riskless young patients. Result: According to the result of this study, penile revascularisation operation is a method that can be applied on patients with erectile dysfunction resulted from organic reasons and that haven't benefitted from madical theraphy and that can be applied before invasive procedures like penile prosthesis implantation. This method has also low costs and can be applied on young patients, especially who hasn't got comorbidity, with high success rates. As is shown in our study, we encountered that forming a good working anastomose line is one of the crucial criteria that define the success of the operation. Measuring bilateral epigastic arteries diameters and flow velocities while doing penile coloured doppler ultrasonography will be helpful for the success of anastomosis at the preoperative period. Thanks to anastomosis, deep dorsal vein contributed to the nutrition of the cavernous tissue through the emisser veins by arterializing and concordantly significant improvement in IIEF scores of the patients is observed objectively and this is supported by a postoperative CT angiography in our study. Besides, as is shown in our study, it is also shown that resistivity index is also an objective criterion used along with post operation patient follow-up IIEF scores, having significant increases at cavernous artery and epigrasic artery resistivity for patients that IIEF increase found and anastomosis openness observed at postoperative period.