Objective: To introduce our experience in diagnosising and treating two types of rare erectile dysfunction (ED).
Subjects and methods: Type 1: three patients of 20 years old, complicated ED due to instability of the penile base. Physical examination explored slim penile base and penis. Nocturnal penile tumescence (NPT) showed several erectile episodes with the hardness reaching 80-100%. Intracavernous injection (ICI) induced 3-4 grade erectile hardness, but the penis could not keep stable and lose the capacity to penetrate into vagina.
Surgery methods: The key point was to strengthen the suspensory ligament of the penis. We made an incision at penile base, and separated the tissue to explore corpora cavernosa. Then we stitched dorsal corpora cavernosa with pubic bone, and suture corpora cavernosa side by side to the pubic arch. Type 2: two cases of 20 years old, complicated ED due to their penis being excessive dorsiflexion. They had to pull their penis towards the abdomen to reach a suitable angle for coitus, but resulting in pain.
Surgery methods: We made an incision below the pubic bone, separated the tissue and explored the penile suspensory ligament, and then cut the penile shallow suspensory ligament and part of deep suspensory ligament.
Results: Three cases of type 1 obtained a good stability of penile base, and had satisfied sexual life without the help of hands. Two cases of type 2 obtained penis erectile angle greater than 90° and had satisfied sexual life.
Conclusions: Besides vascular and nervous factors, other important factors including the stability of the penis base or erectile angle should be considered when diagnosing ED. They could not be distinguished by NPT or other special examinations. Throughly physical examination and comparison analysis helped doctors to reach a correct diagnosis.
