The Use of Radiographic Method of Investigation in the Preoperative Planning of Patients with Venogenic Erectile Dysfunction

Abstract

Purpose: To study the effectiveness of dynamic computer cavernosography at the stage of preoperative examination of patients with venogenic erectile dysfunction (ED).
 Material and methods: 92 patients with venogenic erectile dysfunction were operated. Patients were divided into two groups depending on preoperative planning. Patients in group 1, pharma doppler sonography of the penis was used for preoperative planning. In group 2 – pharma doppler sonography of the penis and dynamic computer cavernosography were used. Resection of the deep dorsal vein of the penis was undergone in patients with proven distal type of shunt. A survey of patients was carried out before surgery and 12 months after surgical treatment according to the validated international rating scales of the erectile function.
 Results: After preoperative planning and surgical treatment scores of erectile function in both groups changed. In both groups the proportion of patients with a severe degree of ED significantly decreased. The level of assessment of the quality of erection in group 1 remained almost the same, but 26 % of patients recorded a maximum score of 4. In group 2 the majority of patients (56 %) described their condition with a maximum score of 4 points. The assessment of quality of life using a scale of “QOL” after surgical treatment was described by patients in the following way: “excellent”: in group 1 and 3 %, in group 2 and 7 %; “good”: in group 1 – 34 %, group 2 – 63 %; “satisfactory”: 3 % in both groups; “poor”: in group 1 – 50 %, group 2 – 15 %. These data confirm that resection of the deep dorsal vein of the penis statistically significantly (p < 0.0001) improves the quality of life of patients with vein-occlusive mechanism of erectile dysfunction. However, in group 2 due to the proposed preoperative planning and pathophysiologically due to the definition of specific indications for surgical intervention we achieved the best estimates of quality of life (p = 0.0108).
 Conclusion: Preoperative planning based on the application of dynamic computer cavernosography, provides a statistically significant (p = 0.0061) improvement of the results of resection of the deep dorsal vein of the penis in patients with vein-occlusive mechanism of ED.