CT Cavernoso Graphy and Penile Venous Leak

Abstract

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.