This document discusses penile erection and sexual dysfunction following transurethral resection of the prostate (TURP). It describes the anatomy related to erection, ejaculation, and venous drainage of the penis. It then discusses the incidence of sexual side effects like retrograde ejaculation following TURP, as well as risk factors. The document also introduces the Sexual Health Inventory for Men (SHIM) questionnaire for evaluating erectile dysfunction severity.

2. Hemodynamics of penile
erection
• Erection and detumescence are hemodynamic
events regulated by relaxation and erection of
the corporal smooth muscles

3. Flaccid state of penis

4. Erect state of penis (veno-
occlusive mechanism)

5. Innervation of penis
Relations of cavernous nerves
to urethra are as follow:
 Posterolateral to apex of
prostate (5 & 7 o’clock).
 Lateral to membranous
urethra (3 & 9 o’clock).
 Anterior to bulbar urethra
(1 & 11 o’clock) where it
enter the hilum of penis.

6. Arterial supply of penis

7. Venous drainage of penis

8. Ejaculation
• Efferent signals traveling in
hypogastric nerve activate
secretions and transport sperm
from the distal epididymis, vasa
deferentia, seminal vesicles, and
prostate to the prostatic urethra.

9. Ejaculation
• Coordinated closing of the internal
urethral sphincter, relaxation of the
external sphincter and rhythmic
contractions of the bulbospongiosus
muscles direct the semen into the
bulbous urethra (emission).

10. Sexual dysfunction following
TURP
Incidence of sexual dysfunction:
• Retrograde ejaculation is an established
compliaction of TURP (upto 83%).
• Effect on other aspects of erectile function is
still controversial (range from 5-13%).
(Munteuer et al., 2006)

11. Risk factors for ED after TURP
• Risk factors for sexual dysfunction include:
 Capsular perforation adjacent to
neurovascular bundle at the prostatic apex.
 Small adenoma.
 D.M.
(Munteuer et al., 2006)

12. ED after PKVP (plasma kinetic
vaporization of prostate)
• Incidence: 10.6%
• Risk factors for sexual dysfunction include:
 Capsular perforation.
 D.M.
(Xiao yong et al., 2006)

13. Sexual Health Inventory for
men (SHIM)

14. SHIM score
• Total score ranges from 5 to 25 based on the 5
questions.
• Each point is rated on likert score of:
1= least functional; …….; 5= most functional.
(Prost and Buvat, 2006)

15. SHIM score
• The score characterizes ED severity as follows:
 22 – 25 = normal EF.
 17 – 21 = mild ED.
 12 – 16 = mild to moderate ED.
 8 – 11 = moderate ED.
 < 7 = severe ED.
(Prost and Buvat, 2006)