Histomorphometry of penile smooth muscle fiber in severe erectile dysfunction
Keywords:
Impotence, Penis, Biopsy, Smooth muscle, Computer-assisted image processingAbstract
CONTEXT AND OBJECTIVE: Smooth muscle fiber has fundamental importance in erection. Alterations in its function or quantity may be associated with erectile dysfunction. The study objective was to assess the proportion of penile smooth muscle fiber in patients with severe erectile dysfunction. DESIGN AND SETTING: Clinical study, in the Sexual Dysfunction Group, Universidade Federal de São Paulo (Unifesp), and in the Anatomy Laboratory, Universidade Estadual do Rio de Janeiro (UERJ). METHODS: Twenty patients with severe erectile dysfunction were selected to form two groups of ten patients: one with normal arterial flow (age range: 44 to 78 years) and the other with altered arterial flow (age range: 38 to 67 years). These groups were compared with a group formed by ten cadavers aged 18 to 25 years that were presumed to have been potent. Quantification of the smooth muscle fibers was done by means of an immunohistochemical study. RESULTS: The proportion of smooth muscle fiber found was 41.15% for the control group. The pa- tients with erectile dysfunction and normal arterial flow presented 27.24% and those with altered arterial flow presented 25.74%; 19 patients presented at least one chronic disease or risk factor for erectile dysfunction, with prominence for diabetes mellitus, systemic arterial hyperten- sion and smoking. CONCLUSION: Among patients with severe erectile dysfunction, the arterial flow on its own does not present interference in the proportion of smooth muscle fiber. The diminution of the proportion of smooth muscle fiber may result from chronic diseases and vascular risk factors.
Downloads
References
Burnett AL. Nitric oxide in the penis: physiology and pathology. J Urol. 1997;157(1):320-4.
Rajfer J, Aronson WJ, Bush PA, Dorey FJ, Ignarro LJ. Nitric oxide as a mediator of relaxation of the corpus cavernosum in response to nonadrenergic, noncholinergic neurotransmission. N Engl J Med. 1992;326(2):90-4.
Christ GJ, Richards S, Winkler A. Integrative erectile biology: the role of signal transduction and cell-to-cell communication in coordinating corporal smooth muscle tone and penile erection. Int J Impot Res. 1997;9(2):69-84.
Malovrouvas D, Petraki C, Constantinidis E, et al. The contribu- tion of cavernous body biopsy in the diagnosis and treatment of male impotence. Histol Histopathol. 1994;9(3):427-31.
Wespes E, Depierreux M, Schulman CC. Use of Biopty gun for corpus cavernosum biopsies. Eur Urol. 1990;18(2):81-3.
Hussain S, Nehra A, Goldstein I, Krane RJ. Percutaneous core biopsy of the penis. Int J Impot Res. 1998;10(1):57-9; discussion 59-60.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822-30.
Broderick GA. The initial visit: self-administered questionnaires. In: Broderick GA, Donatucci CF, Montague DK, Stief CG. Male sexual dysfunction: diagnostic and treatment options. American Urological Association Annual Meeting courses handout. New Orleans;1998.
Oates CP, Pickard RS, Powell PH, Murthy LN, Whitting- ham TA. The use of duplex ultrasound in the assessment of arterial supply to the penis in vasculogenic impotence. J Urol. 1995;153(2):354-7.
Lue TF, Hricak H, Marich KW, Tanagho EA. Vasculogenic im- potence evaluated by high-resolution ultrasonography and pulsed Doppler spectrum analysis. Radiology. 1985;155(3):777-81.
Quam JP, King BF, James EM, et al. Duplex and color Doppler sonographic evaluation of vasculogenic impotence. AJR Am J Roentgenol. 1989;153(6):1141-7.
Lopez JA, Espeland MA, Jarow JP. Interpretation and quantifica- tion of penile blood flow studies using duplex ultrasonography. J Urol. 1991;146(5):1271-5.
Lee B, Sikka SC, Randrup ER, et al. Standardization of penile blood flow parameters in normal men using intracavern- ous prostaglandin E1 and visual sexual stimulation. J Urol. 1993;149(1):49-52.
Rhee E, Osborn A, Witt M. The correlation of cavernous systolic occlusion pressure with peak velocity flow using color duplex Doppler ultrasound. J Urol. 1995;153(2):358-60.
Watt A, Policarpo F, editors. The computer image. Boston: Addison-Wesley Professional; 1998.
Efford N, editor. Digital Image Processing. Boston: Addison- Wesley Professional; 1992.
Christ GJ, Richards S, Winkler A. Integrative erectile biology: the role of signal transduction and cell-to-cell communication in coordinating corporal smooth muscle tone and penile erection. Int J Impot Res. 1997;9(2):69-84
Conti G, Virag R. Human penile erection and organic impotence: normal histology and histopathology. Urol Int. 1989;44(5):303-8.
Wespes E, Goes PM, Schiffmann S, Depierreux M, Van- derhaeghen JJ, Schulman CC. Computerized analysis of smooth muscle fibers in potent and impotent patients. J Urol. 1991;146(4):1015-7.
Jevtich MJ, Khawand NY, Vidic B. Clinical significance of ultrastructural findings in the corpora cavernosa of normal and impotent men. J Urol. 1990;143(2):289-93.
Yu MB, Wang XX, Shen LC. Computerized image analysis of smooth muscle fibers in normal Chinese men and impotent patients. Chin Med J (Engl). 1993;106(9):679-81.
Góes PM. Quantificação de fibras musculares lisas, no tecido cavernoso de pacientes potentes e impotentes de causa vascular [thesis]. São Paulo: Faculdade de Medicina da Universidade de São Paulo; 1997.
Sasso F, Falabella R, Gentile G, Servello C, Gulino G. Blood gas changes in the corpora cavernosa: metabolic and histomor- phometric implications in the patient with erectile dysfunction. J Urol. 2003;169(6):2270-4.
Moreland RB. Is there a role of hypoxemia in penile fibrosis: a viewpoint presented to the Society for the Study of Impotence. Int J Impot Res. 1998;10(2):113-20.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61.
Melman A, Gingell JC. The epidemiology and pathophysiology of erectile dysfunction. J Urol. 1999;161(1):5-11.
Mannino DM, Klevens RM, Flanders WD. Cigarette smoking: an independent risk factor for impotence? Am J Epidemiol. 1994;140(11):1003-8.
Dai Q, Silverstein AD, Davies MG, Hagen PO, Donatucci CF, Annex BH. Systemic basic fibroblast growth factor induces favorable histological changes in the corpus cavernosum of hy- percholesterolemic rabbits. J. Urol. 2003;170(2 Pt 1):664-8.
