Venous Leak and Erectile Dysfunction
Venous Leak and Erectile Dysfunction
I have a patient who is a normal, young, healthy male, who has complained of long-standing erectile dysfunction since almost adolescence. A diagnosis of venous leak was confirmed using dynamic cavernosometry. What are the next diagnostic procedures and treatment options that are available after the failure of phosphodiesterase inhibitors and prostaglandins, other than penile prosthesis?
Allen D. Seftel, MD
Associate Professor of Urology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, Ohio
In this case, it is important to check the cavernosal arteries, via duplex ultrasound, after intracavernosal injection of a vasoactive agent. It is equally important to have this young man evaluated by a mental health professional, to rule out significant psychological issues.
As far as surgical options, "venous leak" surgery historically has not been very successful, with success rates ranging around 20% to 30%. There are sporadic case reports of successful correction of erectile dysfunction in young men with "pure" venous leak. The clinician must be certain that the patient has pure venous leak, no arterial disease, no significant psychological issues, and that the leak can be isolated to a specific site. Ligation of the vein or veins under these conditions might have greater than 30% success; however, venous leak from several sites decreases the rate of success.
Question
I have a patient who is a normal, young, healthy male, who has complained of long-standing erectile dysfunction since almost adolescence. A diagnosis of venous leak was confirmed using dynamic cavernosometry. What are the next diagnostic procedures and treatment options that are available after the failure of phosphodiesterase inhibitors and prostaglandins, other than penile prosthesis?
Response From the Expert
Allen D. Seftel, MD
Associate Professor of Urology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, Ohio
In this case, it is important to check the cavernosal arteries, via duplex ultrasound, after intracavernosal injection of a vasoactive agent. It is equally important to have this young man evaluated by a mental health professional, to rule out significant psychological issues.
As far as surgical options, "venous leak" surgery historically has not been very successful, with success rates ranging around 20% to 30%. There are sporadic case reports of successful correction of erectile dysfunction in young men with "pure" venous leak. The clinician must be certain that the patient has pure venous leak, no arterial disease, no significant psychological issues, and that the leak can be isolated to a specific site. Ligation of the vein or veins under these conditions might have greater than 30% success; however, venous leak from several sites decreases the rate of success.