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Le pénis

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Le pénis

  1. 1. Le pénis : un laboratoire vasculaire unique Ronald Virag Centre d’Exploration et Traitement de l’Impuissance 8 rue de Duras 75008 Paris www.medisexe.com 62°Congrès de la SFA 9-10 Javier 2008
  2. 2. Le pénis: un laboratoire vasculaire unique Un peu d’histoire 1 <ul><li>Un des organes vasculaires les plus accessibles et sans doute le moins exploré… </li></ul><ul><ul><li>Vinci…….artères </li></ul></ul><ul><ul><li>Varolio…. veines </li></ul></ul><ul><ul><li>De Graaf…balance A-V </li></ul></ul><ul><ul><li>Hunter </li></ul></ul><ul><ul><li>Bérard muscle lisse </li></ul></ul><ul><ul><li>Valentin </li></ul></ul><ul><ul><li>Conti 1950 </li></ul></ul>
  3. 3. Le pénis: un laboratoire vasculaire unique Un peu d’histoire 2 <ul><li>1978: Erection artificielle chez le cadavre: Newman and Northtrup </li></ul><ul><ul><li>Phalloarteriographie </li></ul></ul><ul><ul><li>Cavernographie </li></ul></ul><ul><li>1982: Injection IC </li></ul><ul><ul><li>Manipulation pharmacologique </li></ul></ul><ul><ul><li>Recherche et Tts </li></ul></ul>
  4. 4. Le pénis: un laboratoire vasculaire unique Un peu d’histoire 3
  5. 5. Le pénis: un laboratoire vasculaire unique Un peu d’histoire 4 <ul><li>Recherche fondamentale et appliquée </li></ul><ul><ul><li>Tissu isolés </li></ul></ul><ul><ul><li>Mammifères </li></ul></ul><ul><ul><li>Rongeurs +++ </li></ul></ul><ul><ul><ul><li>Modéliser l’érection et ses pathologies </li></ul></ul></ul><ul><li>Le temps de la biologie moléculaire et de la génétique </li></ul>
  6. 6. Le pénis: un laboratoire vasculaire unique Les deux grands chantiers du CETI <ul><li>A partir de la DE </li></ul><ul><ul><li>Dépistage et prévention des maladies C-V </li></ul></ul><ul><li>Pour le DE </li></ul><ul><ul><li>Comprendre les mécanismes </li></ul></ul><ul><ul><li>Réparer </li></ul></ul>
  7. 7. L’Erection sur le plan moléculaire nNO into SMCs Activation of guanylate cyclase increase level of cGMP Reduction of intracellular Ca 2 Inactivation of the SM fibers contractile mechanisms eNO prostaglandins endothelial hyperpolarizing factors in ECs NO-cGMP route Cavernosal Parasympathetic Nerves vasorelaxation and vasodilation regulation of venous and arterial tone prostaglandins I and E receptors + adenylate cyclase increase level of cAMP K+ (K-ATP) SMC relaxation arterial inflow PGI2-cAMP route Vipergic nerves
  8. 8. Conséquences: nécessité d’explorer les 2 voies d’activation et les 2 cibles <ul><li>L’endothélium </li></ul><ul><ul><li>Systémique </li></ul></ul><ul><ul><ul><li>FMD brachiale </li></ul></ul></ul><ul><ul><ul><li>Pléthysmo.digitale Endopath </li></ul></ul></ul><ul><ul><li>Pénien </li></ul></ul><ul><ul><ul><li>PNORT </li></ul></ul></ul><ul><ul><ul><li>Pléthysmo. </li></ul></ul></ul><ul><li>Le muscle lisse </li></ul><ul><ul><li>Pharmaco-döppler </li></ul></ul>
  9. 9. Qualité du muscle lisse
  10. 10. Qualité de l’endothélium Shear stress Chemical stimuli Vascular smooth muscle Endothelium (Joannides, et al. Circulation ., 1995) N-O
  11. 11. Qualité de l’endothélium <ul><li>Penile NO Release Test (PNORT)° </li></ul><ul><li>Plethysmographie digitale (Endopath) </li></ul>Dysf.Endoth.< 1,67 Normal >2,1 < 1,45
  12. 12. Dysfonction endothéliale systémique et pénienne
  13. 13. Dysfonction endothéliale et DE (DPO-DAO) +(DPO/DAO+1) 2
  14. 14. PNORT et Densité des cellules apoptotiques endothéliales α actine Von Willebrandt Marquage ADN Costa et Virag 2009 JSM on line Tunnel Assay
  15. 15. Synthèse et Algorythme Dysf.endoth.pénienne Pharmaco-Döppler Atteinte artérielle Coroscan + Angioscan pelvien FRA Endopath Autres territoires Echographie dobutamine Dysf.endoth.pénienne isolée Sans atteinte artérielle Fuite caverno-veineuse PNORT Cavernoscan Anomalie de drainage Chirurgie Normal Biopsie Biostimulation
  16. 16. Fuite C-V anatomique
  17. 17. Le pénis: un laboratoire vasculaire unique Les deux grands chantiers du CETI <ul><li>A partir de la DE </li></ul><ul><ul><li>Dépistage et prévention des maladies C-V </li></ul></ul><ul><li>Pour le DE </li></ul><ul><ul><li>Comprendre les mécanismes </li></ul></ul><ul><ul><li>Réparer </li></ul></ul><ul><li>1- Réalité de l’atteinte coronaire dans la DE </li></ul><ul><li>2- % DE et FRV </li></ul><ul><li>3- DE chez les coronariens </li></ul><ul><li>Reprendre l’anatomie vasculaire du pénis </li></ul><ul><li>Poursuivre l’étude cellulaire </li></ul><ul><li>Lésions vasculaires </li></ul><ul><li>Lésions fibreuses </li></ul><ul><li>Lésions cellulaires </li></ul>
  18. 18. Can we prevent or cure apoptosis? L Arginine SuperOxyDismutase Pycnogénol R.Virag et al Angiologie aout-sepyembre 2008,
  19. 19. Can we repair ? <ul><li>Gene Therapy </li></ul><ul><li>Stem cells </li></ul><ul><li>Biostimulation </li></ul>Biostimulation (Protocole Carla-CETI) <ul><li>utilisation de sang autologue </li></ul><ul><li>réinjection intracaverneuse </li></ul>
  20. 20. CETI Biostimulation Pénienne Régénératrice (Protocole Carla-CETI)
  21. 21. <ul><li>Cas n°1 : M… </li></ul><ul><ul><li>45 ans, IIEF-5=7 no ARF </li></ul></ul><ul><ul><li>CVOD </li></ul></ul><ul><ul><li>Artérialisation: Résultat partiel: AI nécessaire* </li></ul></ul><ul><ul><li>4 séances PRP (après Elliovir et RealBuild) </li></ul></ul><ul><ul><li>Rapports sexuels efficaces sans AI (3mois) </li></ul></ul><ul><ul><ul><li>IIEF-5 passé de 12 à 19 </li></ul></ul></ul><ul><ul><ul><li>iPNORT </li></ul></ul></ul><ul><li>M </li></ul>Regenerative penile biostimulation (Protocole Carla-CETI) CETI
  22. 22. <ul><li>Jean Floresco </li></ul><ul><li>G.Tétart </li></ul><ul><li>V.Hastert </li></ul><ul><li>Marc Galiano </li></ul><ul><li>G.Pignot </li></ul><ul><li>I.Souillac </li></ul><ul><li>O.Sibaud </li></ul><ul><li>A.Dana </li></ul><ul><li>B.Martin </li></ul><ul><li>J.F.Paul </li></ul><ul><li>O.Dubourg </li></ul><ul><li>JC Farcot </li></ul><ul><li>Mme de Roquefeuil </li></ul><ul><li>C.Costa </li></ul>PARIS 25 Septembre 2009 Journée Médico-Chirugicale Vasculaire Sofitel Paris-Champs-Elysées Press Club de France Echo Doppler Endo et Exo Laser Radio Fréquence Andrologie Dermato Esthétique Prévention Cardio-Vasculaire Organisation : martinehopkins@mail.com + 33 (0)6 08 81 81 96 www.gelev.fr

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