Penile arteriography in impotence after pelvic trauma

A patient who was impotent following pelvic trauma was evaluated by penile artheriography. The study revealed bilateral disruption of the internal pudendal artery at the level of the urogenital diaphragm. It is concluded that impotence in this case is vasculogenic, although it is not possible to eliminate conclusively the possibility of neurogenic factors. Evaluation of more patients with this new technique of penile arteriography is necessary to establish the frequency of vasculogenic impotence in pelvic trauma. A review of the current literature revealed that impotence is approximately 10 times more common after conventional retropubic urethral realignment for acute prostatomembranous disruption compared to treatment by cystostomy tube alone. Analysis of the pertinent neurovascular anatomy suggests that when impotence is caused by surgical dissection of the periprostatic region the pathogenesis probably is neurogenic because of injury to the prostatic plexus and/or cavernous nerves, and it may be irreversible.