title: Venous leak surgery: long-term follow-up of patients undergoing excision and ligation of the deep dorsal vein of the penis.
abstract: OBJECTIVE
  To review the long-term results and satisfaction of patients after venous leak surgery for the management of impotence caused by a failure of passive venous occlusion.
  
  
  METHODS
  Twenty-seven patients (mean age 56 years, range 26-63) with erectile failure due to venous leakage, diagnosed on colour Doppler imaging (CDI) and pharmacocavernosometry and cavernosography, underwent venous leak surgery. In all cases the deep dorsal vein of the penis was excised and ligated along with any other large accessory veins. Patients were reviewed in out-patients at 3 months and asked to complete a questionnaire 1 year after surgery.
  
  
  RESULTS
  Three months after surgery, 19 of 27 patients (70%) had been able to resume sexual intercourse, 17 (63%) had spontaneous erections and two (7%) required papaverine/prostaglandin E1. One year after surgery, 14 of 22 patients were able to achieve erections sufficient for sexual intercourse, although four of these required self-injection with papaverine. There were no serious complications, and when asked whether or not they would undergo the operation again, 13 of 20 said they would.
  
  
  CONCLUSIONS
  We conclude that venous leak surgery is a useful treatment modality in patients with pure venous leakage proven by pharmacocavernosometry and/or cavernosography, and in whom arteriogenic impotence has been excluded using CDI. These are often desperate patients who would rather accept the risk that this relatively minor procedure may fail in preference to undergoing implant surgery in the first instance or use a vacuum device. However, well-informed consent is essential.
authors.affiliation: Department of Urology, St Mary's Hospital, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Vale
authors.forename: M R
authors.initials: MR
authors.lastname: Feneley
authors.forename: W R
authors.initials: WR
authors.lastname: Lees
authors.forename: R S
authors.initials: RS
authors.lastname: Kirby
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D018783:Impotence, Vasculogenic / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010410:Penile Erection; D010413:Penis / Q000098:blood supply*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014680:Veins / Q000601:surgery