What Nonresponse to Intracavernous Injection Really Indicates: A Determination by Quantitative Analysis

Abstract

Our results indicate that age and erectile dysfunction duration alone are the most important variables affecting the results of an intracavernous injection test. However, in patients older than 40 years with a greater than 2-year history of erectile dysfunction failure to respond to intracavernous injection testing is most closely associated with venous insufficiency, as evidenced by the high ROC values for variables indicative of venous insufficiency, namely maintenance flow, pressure loss and the resistive index. Therefore, nonresponse to an office intracavernous injection test in an older patient with erectile dysfunction of long duration is most likely due to venous leakage. If only 1 confirmatory test is possible, cavernosometry provides the most information.

Different hemodynamic responses by color Doppler ultrasonography studies between sildenafil non-responders and responders

“…Veno-occlusive dysfunction alone, or combined with arterial disease, is the hemodynamic abnormality causing non-response to intracavernous pharmacotherapy [13]. However, non-response to intracavernous vasodilator injection in an older patient with a long duration of ED is most likely to the result of venous insufficiency [14]. Age and the competence of smooth muscle relaxation to vasoactive agents might play a major role in the difference of erectile response in the present study, that is, the mean age of patients in the non-responder group was 15 years older than in the responder group.…”

Testosterone Undecanoate Restores Erectile Function in a Subset of Patients with Venous Leakage: A Series of Case Reports

“…We plan to pursue future studies with larger numbers of patients and stimulate other investigators to assess and document the potential beneficial treatment of this therapy in patients with vasculogenic erectile dysfunction. If the effects of testosterone in restoring erectile function and preventing venous leakage could be confirmed in a large number of patients, this would be a major clinical advancement because venous leakage is among the most common causes of erectile dysfunction [19–22] and often difficult to manage by first‐line phosphodiesterase inhibitor therapy [23].…”

A young man with position-dependent erectile dysfunction: diagnostic work-up and interventional therapy of an arteriovenous malformation

“…Because surgical treatment outcomes are limited, minimal invasive approaches like percutaneous embolization seem justified. This holds especially true as otherwise a penile prosthesis is the final option 17. After interventional venoablative treatment initial response rates are around 70-80%, while lasting treatment success is found in <30%.…”