음낭-음경 발기 조영술로 살펴본 발기부전과 정계정맥류의 상관관계

Abstract

[한글]

정계정맥류와 발기부전의 상관관계에 대해서 아직까지 정설이 없는 상태이며, 임상적으로 이 두 질환이 동반되는 경우는 드물지 않게 관찰할 수 있다.1989년 6월부터 1990년 6월까지 발기부전이나 정계정맥류를 주소로 연세대학교 영동세브란스병원에 내원한 194명

을 대상으로 한번의 방사성 등위원소 주입을 통하여 두 질환을 동시에 진단할 수 있는 '음낭-음경 발기조영술'을 시행한 결과 다음과 같다.

1 두 질환이 동반된 환자는 85명(18.67%)이었다.

2. 발기부전의 원인별 분류에서 정계정맥류가 동반된 환자에서 동반되지 않은 환자보다 호르몬성 발기부전의 빈도가 더 많았다.

3. 두 질환이 동반된 환자 중에서 고위내정계정맥 결찰술을 받은 환자 15명에서 자각증상으로는 10명(55.7%)에서 호전이 있었고 음낭-음경 발기조영술로는 7명중5명(701.4%)에서 호전이 있었다.

4. 두 질환이 동반된 환자의 발기부전의 원인은 심인성 10, 내분비성 3, 혈관성 2로 분류되었으며, 심인성 환자10명에서 정계정맥류 수술 후 음경 발기조영술의 type(3명중 3명

)과 자각 중상(10명중 7명)의 호전이 있었고, 혈관성 발기부전환자 2명에서는 정계정맥류 수술 후 음경 발기조영술, Rigiscan, 자각 증상의 호전이 없었다. 호르몬성 발기부전 환

자3명에서 정계정맥류 수술후 음경발기조영술의 호전(2명중 7명), Rigiscan의 호전(2명중 1명), 자각 증상의 호전(3명 모두), GnRH 검사의 정상 반응화(2명중 2명), 및 Testoster

one치의 호전(2명중 1명)이 있었다.

이상의 결과로 정계정맥류와 발기부전의 상관관계에 있어서 심인성, 내분비성, 혈관성 등의 원인들이 복합적으로 작용하는 것으로 나왔으나 내분비적 요소가 상당히 관여하고 일부 혈관계 원인도 관여하는 것으로 추측된다. 심인성 원인으로 진단된 것들 중에도 자

각 증상 등의 호전이 많은 것을 보면 단순한 심인성만이 아닌 내분비성 영향도 있을 것으로 추측된다. 그러므로 이러한 내분비성 원인과 혈관성 원인에 대해서는 더 많은 임상경험에 의한 연구가 필요하다고 사료된다.

The relationship between the varicocele and the erectile failureby the

"scrota-penogram"

In Rae Cho

Department of Medical Science The Graduate School, Yonsei University

(Directed by Professor Hyung Ki Choi)

The relationship between the varicocele and the erectile failure has not been

fully explained yet, but clinically it is not uncommon to see the patients in which

these two conditions coexist. Comhaire and Vermeulen (1975) reported that the

decreased testosterone level might have contributed to the impairment of the sexual

function in their varicocele patients, but Nahoum and Freire(1985) reported the

possibility of a nonhormonal mechanism.

Recently we developed a new diagnostic method, which we call "scroto-penogram" -

a concomitant study for the varicecele and the erectile failure. We examined with

this method 194 patients which visited the Department of Urology with chief

complaint of erectile failure or scrotal mass. The results are as fellow.

1. 36(18.6%) impotent patients had varicocele.

2. In the etiological subclassification of the erectile failure, between the

impotent patients with varicocele and without varicocele there was a statistically

significant difference (p<0.05), and the incidence of the hormonally impotent

patients with varicocele was higher than without varicocele.

3.Among 15 patients receiving surgery for varicocele, varicecele grade Ⅱ was11,

grade Ⅲ 4, and in the etiological subclassification of the erectile failure,

psychogenic 10, hormonal 3, and vascular 2 which was venogenic 1,arteriogenic and

venogenic 1. After the ligation of the left internal spermatic vein, the type of

the audiovisual stimulation (AVS)-penogram(71.4%, 5 among 7) and the subjective

symptoms (76.7%, 10 among 15) were improved.

4. The type of the AVS-penogram (3 among 3) and the subjective symptoms (7 among

10) of the 10 psychogenically impotent with varicocele patients were improved after

varicocele operation.

5. The type of the AVS penogram, Rigi scan, and the subjective symptoms of 2

vasculogenically impotent with varicocele patients were not improved after

operation.

6. The type of the AVS penogram (2 among 2), Rigi scan (1 among 2), subjective

symptoms (3 among 3), response of the GnRH test (2 among 2), and the level of serum

testosterone (1 among 2) of 3 hormonally impotent with varicocele patients were

improved after operation.

The above results might suggest that the psychological and endocrinological

factors were significantly involved in the relationship between these two

conditions. To clarify the endocrinological effect of varicocele on erectile

failure, further studies in the hormonally impotent with varicocele patients may be

needed. And varicocele results secondary to incompetent or absecent valves in the

spermatic veins, so we cannot rule out the association of the incompetence of the

penile vein. To clarify the association with the incompetence of the penile vein,

further studies suck as dynamic infusion carvernosometry and carvernosography in

the venognically impotent with varicocele patients may be needed.

[영문]

The relationship between the varicocele and the erectile failure has not been fully explained yet, but clinically it is not uncommon to see the patients in which these two conditions coexist. Comhaire and Vermeulen (1975) reported that the

decreased testosterone level might have contributed to the impairment of the sexual function in their varicocele patients, but Nahoum and Freire(1985) reported the possibility of a nonhormonal mechanism.

Recently we developed a new diagnostic method, which we call "scroto-penogram" - a concomitant study for the varicecele and the erectile failure. We examined with this method 194 patients which visited the Department of Urology with chief complaint of erectile failure or scrotal mass. The results are as fellow.

1. 36(18.6%) impotent patients had varicocele.

2. In the etiological subclassification of the erectile failure, between the impotent patients with varicocele and without varicocele there was a statistically significant difference (p<0.05), and the incidence of the hormonally impotent

patients with varicocele was higher than without varicocele.

3.Among 15 patients receiving surgery for varicocele, varicecele grade Ⅱ was11, grade Ⅲ 4, and in the etiological subclassification of the erectile failure,

psychogenic 10, hormonal 3, and vascular 2 which was venogenic 1,arteriogenic and venogenic 1. After the ligation of the left internal spermatic vein, the type of the audiovisual stimulation (AVS)-penogram(71.4%, 5 among 7) and the subjective symptoms (76.7%, 10 among 15) were improved.

4. The type of the AVS-penogram (3 among 3) and the subjective symptoms (7 among 10) of the 10 psychogenically impotent with varicocele patients were improved after varicocele operation.

5. The type of the AVS penogram, Rigi scan, and the subjective symptoms of 2 vasculogenically impotent with varicocele patients were not improved after operation.

6. The type of the AVS penogram (2 among 2), Rigi scan (1 among 2), subjective symptoms (3 among 3), response of the GnRH test (2 among 2), and the level of serum testosterone (1 among 2) of 3 hormonally impotent with varicocele patients were improved after operation.

The above results might suggest that the psychological and endocrinological factors were significantly involved in the relationship between these two conditions. To clarify the endocrinological effect of varicocele on erectile

failure, further studies in the hormonally impotent with varicocele patients may be needed. And varicocele results secondary to incompetent or absecent valves in the

spermatic veins, so we cannot rule out the association of the incompetence of the penile vein. To clarify the association with the incompetence of the penile vein, further studies suck as dynamic infusion carvernosometry and carvernosography in

the venognically impotent with varicocele patients may be needed.