Diagnostic value of selective internal pudendal pharmaco-arteriography in posttraumatic impotence

Jung, Chung Sub; Kim, Sae Chul

Abstract

Selective internal pudendal pharmaco-arteriographies were performed in 38 posttraumatic arteriogenic impotent patients who were supposed to undergo vascular reconstructive surgeries. The arteriographic findings in accordance with trauma character were analyzed and compared with penile brachial index (PBI), duplex sonogram of cavernosal artery and cavernosal artery occulusive pressure (CAOP). The results were obtained as follows : l. The arterial stenoses were found on both sides in 12 (63.1%) out of l9 patients of pelvic bone fracture with urethral rupture, and found on either one (3) or both sides (4) in 7 patients of pelvic bone fracture without urethral rupture and urethral rupture without pelvic bone fracture. The arteriograms were norma1 on both sides in 2 out of 7 patients of vertebral fractures and in one patient of electric burn on glans. 2. The stenotic lesions were most commonly Found in common penile artery (63.5%) followed by proximal cavernosal artery with or without dorsal artery (34.6%) and only one case of distal pudendal artery. Complete obstruction (66.7%) was most common in the common penile artery, whereas partial obstruction (77.8%) was most common in the proximal cavernosal artery. 3. Concerning site of the obstruction in accordance with the trauma character the stenosis occurred more frequently in the common penile artery after pelvic bone fracture with urethra` rupture and in the proximal cavernosal artery after penile injury, and occurred with similar frequency either in the common penile artery or in the proximal cavernosal artery after pelvic bone fracture without urethral rupture and urethral rupture without pelvic bone fracture. 4. Out of fourteen cases of complete or partial obstruction on the arteriograms, 9 (64.3%) have abnormal findings on the duplex sonograms. Among l2 cases of obstruction on the arteriogram, only 4 (33.3%) were less than O.7 of PBI. Four cases of normal arteriogram shower abnormal duplex sonogram but normal PBI in all. 5. CAOP was 20 mmHg or more lower than brachial systolic pressure in 6 (66.7%) out of 9 cases or obstruction on the arteriogram. In conclusion, selective internal pudendal pharmaco-arteriography seems to be a valuable diagnostic method to investigate enile arterial traumatic obstruction. However, it is thought that the arteriography should be done complementarily with another methods because it still has limits of specificity and sensitivity.