New Classification of Anomalous Venous Drainage Using Caverno-Computed Tomography in Men with Erectile Dysfunction (original) (raw)
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Diagnostics
Erectile dysfunction caused by venous leakage is a vascular disease in which blood fails to accumulate in the corpora cavernosa due to the abrupt drainage of blood from the penis secondary to an abnormal venous network that affects 1 to 2% of men under 25 years old and about 10 to 20% over 60 years old, who do not raise a sufficient erection for penetrative sex. The study of the venous leak and its characterization in young patients with erectile dysfunction represent a diagnostic challenge, and imaging remains the best way to diagnose this condition. In the article, it is described the methods of execution and the diagnostic role of the cavernous MRI in the study of vasogenic erectile dysfunction from the venous leak, proposing it as a good alternative to the cavernous CT, considering the satisfactory results in terms of diagnostic interpretation, the absence of ionizing radiation, the higher soft tissue resolution of the imaging method and the lower administration of contrast agent.
Erectile Dysfunction and Cavernous Veno-Occlusive Disease
Journal of Men's Health, 2019
GoalTo provide a state-of-the-art literature review on veno-occlusive diseases as a pathomechanism of vascu-logenic erectile dysfunction (ED).MethodsA comprehensive systematic literature search was conducted followed by sorting, review, and summarizing. ResultsThe systematic review of the literature reveals a significant number of recent studies dealing with new minimally invasive methods to provide a potential solution of caverno-venous leakage. Even the long-term results reported demonstrate considerable improvement of ED caused by this condition. Furthermore, 3-D computed tomography cavernosography (CT-cavernosography) is a new technology, which can provide high-resolution images of venous drainage from any angle and shows to be very helpful for both the diagnosis of corporal veno-occlusive dysfunction and the anatomical study of the human penile venous system. The application of this technology may also lead to better strategies in venous leak treatment. Over 30 published studie...
Erectile Dysfunction Caused by Cavernous Leakage
Sexual Disorders and Dysfunctions [Working Title]
Erectile dysfunction (ED) is a big issue in various populations with up to 30% of young men suffering from this condition. Unfortunately, treatment schemes are currently mainly focused on elderly patients with chronic disorders. In younger patients, ED is more a vascular problem, which affects the storage capacity of the penis. The impact of penile blood supply on erectile function was recognized some 500 years ago. At the turn of the twentieth century, the first results of penile venous ligation were published. Simple isolated ligation of the deep dorsal vein in humans for ED due to venous leak is currently not recommended, due to some reported low long-term success rates. This was, as shown in several literature reports, obviously due to insufficient technical possibilities. Technical development in imaging and vascular and endovascular treatment have dramatically evolved our understanding of this underlying condition in the past 20 years and turned this disease into a long-term t...
The Journal of Sexual Medicine, 2009
Introduction. The common surgery for venous leakage was not very successful; unsatisfactory long-term results have reduced the indications for venous surgery for erectile dysfunction (ED). Aims. To assess the outcomes of embedding the deep dorsal vein of the penis (EDDVP), a new surgical technique used in patients with penile deep dorsal venous leakage of ED. Methods. Between December 2001 and November 2007, 17 patients diagnosed with penile deep dorsal venous leakage of ED underwent embedding the deep dorsal vein of the penis. Main Outcome Measures. All cases were available for follow up by using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) scoring system and penile color Doppler ultrasound. Dynamic cavernosography were also assessed in three patients at 3 months postoperatively. Results. After surgery, 14 patients were able to achieve satisfactory intercourse and three had sufficient erection after oral sildenafil (50-100 mg). The IIEF-5 scoring changed from a preoperative mean IIEF-5 score of 8.8 Ϯ 3.9 to 20.8 Ϯ 4.1 (P < 0.05). Peak systolic velocity (average of right and left cavernosal arteries) changed from 41.9 Ϯ 7.7 cm/ second to 44.2 Ϯ 9.2 cm/second (P > 0.05), resistance index changed from 0.79 Ϯ 0.1 to 1.00 Ϯ 0.0 (P < 0.05), and venous velocity changed from 8.4 Ϯ 4.0 cm/second to 0.0 Ϯ 0.0 cm/second (P < 0.05). Dynamic cavernosography demonstrated a smooth flow of the deep dorsal vein during the flaccid phase. During the tumescent phase, the deep dorsal vein of the penis was compressed between the dilated sinusoidal spaces and the tunica albuginea and resulted in venous drainage blockade. And then the hardness of erection was improved and maintained. Conclusions. The new surgical technique of EDDVP is a simple operative procedure, which seems to be efficient in the treatment of penile deep dorsal venous leakage of ED. Zhang B, Chen J, Xiao H, Zhang Y, Cai L, Tao X, Qi T, and Ban D. Treatment of penile deep dorsal venous leakage of erectile dysfunction by embedding the deep dorsal vein of the penis: A single center experience with 17 patients.
Experience in diagnosis and treatment of impotence caused by cavernosal leak syndrome
Journal of Vascular Surgery, 1989
TO delineate neural, arterial, and venous components contributing to impotence, we used a previously described noninvasive screening sequence combined with stimulation of artificial erection with papaverine injection, selective pudendal arteriography (SPA), and dynamic cavernosography (DC). Among 572 men with impotence, age range 17 to 78 years (average age 54.8 years), 26 men with potential cavernosal leaks in absence of other factors were identified; 16 underwent DC; among these five had normal cavernosal venous drainage. Eight men with abnormal cavernosal venous drainage required cavernous infusion flow rates higher than 120 ml/min to obtain erection and higher than 40 ml/min to maintain erection. Radiographic studies showed cavernosal leakage in all eight patients. Eight men, ages 39 to 61 years, underwent surgical ablation of abnormal cavernosal venous drainage. Among these, five men have had excellent results for up to 3 years. One failure was related to unrecognized penile arterial disease later shown by SPA. In two men small doses of papaverine now induce erection. We now recommend SPA before DC to nile out an arterial abnormality. Accurate identification of factors contributing to erectile failure is critical for successful treatment; in this experience candidates for correction of cavernosal leak syndrome were uncommon. (J VASe SURG 1989;9:117-21.)
Investigation of the venous system in impotence of vascular origin
Urologic radiology, 1984
Vascular pathology is responsible for about 25% of cases of male impotence. Pudendal arteriography has been the object of numerous publications. Venous conditions explain the majority of erectile dysfunctions in patients with normal arterial anatomy. We have performed cavernography in 30 patients, with monitoring of intracavernous pressure and flow measurement. Cavernograms allowed study of the corpora cavernosa and the venous drainage. Cavernography not only helps in understanding the mechanism of erection but also is essential to the successful treatment of pathologic venous drainage.
CT Cavernoso Graphy and Penile Venous Leak
JOJ Urology & Nephrology, 2017
Introduction: The aim of this work was to verify the value of CT-Cavernosography for penile venous leak diagnosis. Furthermore, we evaluated the effectiveness of pelvic vein embolisation with aethoxysclerol in aero-block technique for the treatment of impotence due to venous leakage in men using sildenafil for intercourse. The aim of this procedure was to reduce or eliminate the use of sildenafil. Material and methods: A total of 49 patients with veno-occlusive dysfunction, severe enough for the need of PDE5 inhibitors for vaginal penetration, underwent pelvic venoablation with aethoxysklerol. The mean patient age was 53.5 years. Venous leaks were identified by Color Doppler Ultrasound and CT Cavernosography after intra-cavernousal prostadil injection. Under local anesthesia a 5F-Angioport was inserted antegrade into the penile deep dorsal penile vein. Aethoxysklerol 3% as sclerosing agent was injected in air-block under Valsalva manoeuver. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Additionally, a pre-and post-therapeutical IIEF-5 score was performed. Results: At a 12 month follow-up 40 out of 49 patients (81.63%) reported to have erections sufficient for vaginal insertion without the use of any drug or additional device. 4 (8.16%) patients did not report any betterment. Mean IIEF-Score and IIEF-Score-Differences after intervention see Figure 1 & 2. No serious complications occurred. Conclusion: Our new pelvic venoablation technique using pre-operative Ct-cavernosography and aethoxysklerol in air-block technique was effective and minimally invasive. All patients were able to perform sexual intercourse without the previously used dosage of their PDE5 inhibitor. This new method may help in patients with contra-indications against PDE5 inhibitors, in patients who cannot afford the frequent usage of expansive oral medication or those who do not fully response to PDE5-inhibitors.
Penile venous anatomy: application to surgery for erectile disturbance
Asian Journal of Andrology, 2002
The structure of the human penile venous system has been well studied, but disappointing outcomes of penile venous surgery in certain patients have called into question on the anatomy. We planned to extend the anatomic knowledge with the ultimate goal of improving operative success. Thirty-five patients, who had undergone penile venous surgery, complained of poor erection developed gradually 6 months to 7 years postoperatively. Cavernosography was performed again during their return visit. Seven new patients underwent spongiosography followed by immediate cavernosography. Eleven male cadavers were carefully dissected. The anatomical findings were applied to venous surgery in 155 patients, who were then followed with the International Index of Erectile Function Questionnaire-5 (IIEF-5). Imaging observation demonstrated that the deep dorsal vein served as a common vessel of the corpora cavernosa and corpus spongiosum. A prominent cavernosal vein was found coursing along each corpus ca...