Structural analysis of the corpora cavernosa in patients with ischaemic priapism.

STUDY TYPE Therapy (case series). LEVEL OF EVIDENCE 4. OBJECTIVE To evaluate, using quantitative and qualitative methods, the changes in the corpora cavernosa of patients with ischaemic priapism. PATIENTS AND METHODS We obtained samples of corpora cavernosa from seven patients with ischaemic priapism (mean age 38 years, range 28-44) who had a cavernous-glandular shunt. The control tissues were fragments of corpora cavernosa obtained from autopsies of seven age-matched men who died from causes unrelated to the urogenital tract. Histochemical and immunohistochemical techniques were used to assess and quantify the extracellular matrix and smooth muscle fibres. The volumetric density of smooth muscle, elastic fibres and collagen were determined in corpora cavernosa. RESULTS From the stereological analysis the mean (sd) values of volumetric density were: for collagen, control 34.76 (4.64), priapism 39.64 (2.91) (P = 0.002); elastic system fibres, controls 28.10 (2.85), priapism 36.10 (3.06) (P = 0.001); smooth muscle fibres, controls 43.37 (4.96), priapism 26.48 (5.00) (P < 0.001). There were significantly more fibrous elements of the connective tissue and significantly fewer smooth muscle fibres in the corpora cavernosa of patients with ischaemic priapism than in controls. CONCLUSION Ischaemic priapism is associated with early and significant changes in the components of the extracellular matrix and smooth muscle fibres of the corpora cavernosa. This could explain the frequent occurrence of erectile dysfunction found in patients with ischaemic priapism.