PUDENDAL ARTERY SYNDROME WITH ERECTILE DYSFUNCTION - TREATMENT BY PUDENDAL CANAL DECOMPRESSION

Pudendal artery syndrome (PAS) was studied in 10 patients with erectil e dysfunction (ED). Ages ranged from 38 to 55 years. All had chronic c onstipation and straining at stool, absent nocturnal penile tumescence , low penobrachial pressure index (p < .01), low peak flow velocity (p < .001), and a diameter increase (p < .0001) upon duplex ultrasonogra phy screening. Four of the 10 patients had perineal hypoesthesia, prol onged bulbocavernosus reflex (p < .05), and pudendal nerve terminal mo tor latency (p < .05), and weak anal reflex and EMG activity of the ex ternal anal sphincter. The levator EMG activity was reduced in all pat ients. Intracavernous papaverine injection induced partial erection af ter a period longer than normal. Selective pudendal arteriography show ed narrowing or obstruction of the distal part of the internal pudenda l artery OPA) on both sides with poorly or nonvisualized penile arteri es. A generalized arterial disease was excluded and pudendal artery co mpression in the pudendal canal (PC) was suspected as causing ED. The narrow or obstructed part of the IPA corresponds to the part in the PC . Four of the 10 patients had manifestations of pudendal neuropathy in addition to IPA compression. Pudendal canal decompression (PCD) was p erformed through a perineal approach. ED improved in 8 of the 10 patie nts 3-6 months postoperatively. Two of the 4 patients who had pudendal arteriopathy combined with neuropathy did not improve. In conclusion, the 10 patients with ED had common clinical and investigative finding s that constitute the pudendal artery syndrome. PCD effected improveme nt in 80% of the cases.