[Veno-occlusive dysfunction as a cause of erectile impotence: therapy of venous leak with retrograde embolization of the internal pudendal vein].
"Venous leak impotence" remains a therapeutic challenge as long term success rates with all interventions are only 50%. Surgical venous ligation is a well established procedure, yet not all pathological venous groups can always be occluded. Retrograde embolisation of angiographically identified pathological venous groups represent a promising alternative to surgical isolation and antegrad embolisation of deep dorsal penile veins. Four young men (19-42 years) presented with complete loss of erection. Vaginal intercourse was impossible. Pharmaco-duplex sonography with Prostaglandin E, 10-20 micrograms demonstrated normal arterial flow in all 4 penile arteries but even after intra-cavernosoal injection of Prostaglandin E, 20 micrograms no complete erection was achieved. Dynamic infusion cavernosometry showed increased maintenance flow. Cavernosography showed a venous leak involving the deep dorsal penile vein in all four cases. Embolisation was carried out via the femoral vein by coaxial technique using Histoacryl-Lipiodol solution in order to embolise all angiographically identified insufficient veins. At one year follow up all 4 patients still achieved spontaneous erections without any additional medical treatment.
Basche
St
S
Institut für Bildgebende Diagnostik, Helios Klinikum Erfurt. s.basche@erfurt.helios-kliniken.de
Eger
C
C
Elsebach
K
K
Ulshöfer
B
B
D000328:Adult; D004621:Embolization, Therapeutic; D005500:Follow-Up Studies; D006801:Humans; D018783:Impotence, Vasculogenic / Q000628:therapy*; D008297:Male; D010413:Penis / Q000098:blood supply; D010690:Phlebography; D011458:Prostaglandins E; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
D011458:Prostaglandins E