Anatomy, Pathophysiology, Molecular Mechanisms, and Clinical Management of Erectile Dysfunction in Patients Affected by Coronary Artery Disease: A Review

Erectile dysfunction (ED) has been defined as the inability to attain or maintain penile erection sufficient for successful sexual intercourse. ED carries a notable influence on life quality, with significant implications for family and social relationships. Because atherosclerosis of penile arteries represents one of the most frequent ED causes, patients presenting with it should always be investigated for potential coexistent coronary or peripheral disease. Up to 75% of ED patients have a stenosis of the iliac-pudendal-penile arteries, supplying the male genital organ’s perfusion. Recently, pathophysiology and molecular basis of male erection have been elucidated, giving the ground to pharmacological and mechanical revascularization treatment of this condition. This review will focus on the normal anatomy and physiology of erection, the pathophysiology of ED, the relation between ED and cardiovascular diseases, and, lastly, on the molecular basis of erectile dysfunction.

Erectile dysfunction and the biochemical/molecular/ regulation of human penile arteries

1.Flow mediated vasodilation as a new, non-invasive diagnostic procedure in the examination of vascular type erectile dysfunction. 2.CNP has a strong vasodilatation effect on human resistance vessels in the presence of NO synthase and cyclooxygenase enzyme inhibitors 3.That relaxation demonstrates a similar characteristics as an EDHF released by Ach 4.CNP has a smooth muscle cells hyperpolarization effect similar to Ach 5.Our examinations prove CNP is an EDHF in human penile resistance vessels which plays an essential role in the reduction of vessel tone supporting erection. 6.CNP or its similar compounds may be successful in the treatment of erectile dysfunction. 7.NO and EDHF take part in the endothelium dependence relaxation human penile intracavernosus arteries. 8.BKC channels play an essential role in the establishment of the effect enduced by both of NO and EDHF 9.During our examination the opening compounds of BKC channels are assumed to be effective in the treatment of disregulation of penile arteries. 10.The Hungarian implementation of female to male sexual reassignment operation Development of the surgical technique in our Department of Urology has lead to better functional and esthetical results. These modifications are the following -The turned down u-shape perineal incision was exchanged by median sagittal incision-The expert preparation of neurovascular bundle -Reaching clitoral orgasm a greater part of the glans is used at the creation of clitoris, one part of it is deepithelialized and it is sunk under the skin. The fixing sutures of the neo clitoris is placed into foreskin to avoid circular damage.