„Steal syndrom“ penilní arterie: případová studie a přehled literatury

Case presentatiom of penile artery steal syndrome and literature review

Penile revascularization is a re-emerging surgical approach ideally suited for young patients with isolated traumatic vasculogenic erectile dysfunction (ED) and no risk factors. We reviewed the literature on penile revascularization and present the interesting case of a 27-year-old man with severe organic ED attributed to a fall onto his back at age 14. Diagnostic work-up revealed severe insufficiency of the left cavernosal artery, with no evidence of venous leak. The patient underwent operative penile revascularization with documented patent anastomosis according to penile duplex Doppler ultrasound, but his ED continued post-operatively. Subsequent arteriography was performed and revealed a left-sided steal phenomenon due to an aberrant obturator artery arising from the donor inferior epigastric artery. The patient underwent successful embolization of the obturator artery, with resolution of the steal and improvement in erectile function. We report this case as Penile Artery Steal Syndrome (PASS), an iatrogenic cause of ED attributable to revascularization in the setting of anomalous vasculature.

Key words:
penile artery steal syndrome (PASS), microarterial bypass, erectile dysfunction, embolization, pelvic steal syndrome

Autoři: J. G. Pavlinec; T. S. Hakky; J. Emtage; D. Martinez; R. Simon; J. Parker; R. Munarriz; K. Massis; R. E. Carrion
Vyšlo v časopise: Urol List 2013; 11(4): 18-24

Souhrn

Revaskularizace cévního řečiště penisu je ideální operační technikou pro léčbu mladých pacientů s izolovanou erektilní dysfunkcí (ED) traumatické vaskulogenní etiologie bez jakýchkoli rizikových faktorů. V tomto článku hodnotíme publikace zabývající se technikami penilní revaskularizace a prezentujeme zajímavý případ 27letého muže se závažnou organickou ED, jejíž příčinu lze připisovat pádu na záda ve 14 letech. Diagnostické vyšetření prokázalo závažnou insuficienci levé kavernózní arterie, bez známek žilního úniku. Pacient podstoupil penilní revaskularizaci a ačkoli dopplerovské ultrazvukové vyšetření prokázalo průchodnou anastomózu, ED po výkonu přetrvala. Arteriografie odhalila přítomnost tzv. „steal syndromu“ na levé straně v důsledku aberantní obturátorové arterie, odstupující z dárcovské dolní epigastrické arterie. Pacient podstoupil úspěšnou embolizaci obturátorové arterie, která vedla k vyřešení steal syndromu a ke zlepšení erektilní funkce. Klasifikujeme tento případ jako steal syndrom penilní arterie (PASS); jedná se o iatrogenní příčinu ED, způsobenou pravděpodobně revaskularizační operací v kontextu aberantní vaskulatury.

Klíčová slova:
„steal syndrom“ penilní arterie (PASS), mikroarteriální bypass, erektilní dysfunkce, embolizace, pánevní „steal syndrom“

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