Advances in the vascular pathology of male erectile dysfunction.

The arterial and venous vascular process involved in the physiology of penile erection is described. In the differential diagnosis of impotence the clinical history remains essential, allowing an organic or functional origin to be strongly suspected, although not positively diagnosed. Vascular arterial impotence can be suspected with the functional triad insufficient erections, feeling of cold in the penis, and ejaculation with the penis flaccid. Erectile impotence of venous origin can be suspected from a very suggestive sign: the patient can maintain his erection more easily when standing. To confirm these diagnoses, we use a thermographic study of the penis, with a cooling test. Selective arteriography of the left and right internal pudendal arteries is carried out, and phlebography and measurement of the venous pressure of the deep dorsal vein of the penis are conducted. Medical and surgical treatments of these vascular disorders are discussed.