Leakage through the Crural Edge of Corpus Cavernosum

We report here on our surgical experience with venous leakage of the cavernous bodies. Out of 159 patients operated on, 134 were availabe for long-term follow-up. Depending on the cavernosographic findings, one of three different surgical procedures was carried out: ligation of the deep dorsal vein of the penis, spongiosolysis, or ligation of the crura. 18% of the patients undergoing ligation of the deep dorsal vein, postoperatively attained spontaneous erections, while 35% needed adjuvant corpus cavernosum autoinjection therapy. Spongiosolysis gave a more favourable result: spontaneous erections in 30% and vasoactive drug-dependent erections in 35%. Crural ligation did not prove successful. No serious complications were encountered postoperatively. Our data suggest that venous surgery should only be offered to a selected group of patients comprising young impotent men with venous leakage, maybe in combination with arterial disease, and patients suffering from distal venous leakage. Old age, neurogenic disorders causing erectile dysfunction, and diabetes mellitus should represent exclusion criteria for venous surgery.

Section: Resultsmentioning

confidence: 99%

Venous Surgery in Erectile Dysfunction

Gilbert¹,

Sparwasser²,

Beckert³

et al. 1992

“…Twenty-three patients were submitted to crural liga tion alone according to the technique previously de scribed [7], 23 patients were submitted to venous ligation according to the technique described by Lue [8], and 11 patients were submitted to venous plus crural ligation.…”

Section: Technique Of Venous Ligationmentioning

confidence: 99%

Venous Surgery in Erectile Dysfunction

Puech-Leão¹

1992

According to the physiopathological process beyond it, veno-occlusive dysfunction (VOD) may be classified in organic or functional VOD. The former is caused by lack of control of smooth muscle relaxation, while the later is related with morphological alterations of the corporeal tissue. The differential diagnosis of those two types is fundamental when venous surgery is to be discussed. Functional VOD may be treated with sex therapy, while in organic VOD, surgical treatment may be considered. The experience with venous surgery for impotence at the H. Ellis Institute was not encouraging. Although a few patients were cured, the long-term follow-up showed that only 9 out of 57 patients were able to have a normal sexual life. New diagnostic tools, as well as a better understanding of the erectile mechanism, may lead to a better selection of cases with an improvement of the results in the future. Today, venous surgery remains as an option to patients with organic VOD, who are willing to accept a 45% probability of improvement for a few months, having been informed about all the other options in the treatment of erectile disorders.

“…Specifical ly, leakage through crura can be addressed by several tech niques. These include corporal ligation with isolation of the crural edge of the corpora cavernosa as well as Gorctex pericavernous banding [21,22]. These operations require a perineal incision, and care should be taken to avoid urethral injury.…”

Section: Alternative Approachesmentioning

confidence: 99%

Management of Corporal Veno-Occlusive Dysfunction

Petrou

Lewis²

1992

Veno-occlusive dysfunction has become a recognized cause of organic impotence. The existence of concomitant arterial and sinus smooth-muscle disease makes this disorder often difficult to diagnose. It rarely can be the sole etiology for impotence. The authors’ experience in the treatment of this disorder in over 100 patients is presented. The authors rely on cavernosometry/pharma-cocavernosometry/pharmacocavernosography and the color duplex Doppler screening test (to eliminate concomitant arterial disease) as the primary diagnostic tools. Twenty-two patients of 58 (38%) have achieved long-lasting success from the surgery so that they are able to have vaginal intercourse. Another 12 patients (21 %) have been improved but must depend upon pharmacological injection therapy to obtain a sufficient erection for intercourse. There has been a 41% failure rate, and these are discussed.