Congruence between veno-occlusive parameters during dynamic infusion cavernosometry: assessing the need for cavernosography.
While dynamic infusion cavernosometry (DIC) is being performed with increasing rarity, some centers continue to use this investigation modality. Cavernosography may be utilized to identify the location of patent venous channels in men with venous leak. In an era when venous ligation surgery is being performed with less frequency, the role of cavernosography has been questioned. This study was conducted to define the congruence between the three parameters (flow-to-maintain (FTM), pressure decay (PD) and cavernosography) used in the diagnosis of venous leak during DIC. Established values for the three parameters were utilized and the diagnosis of venous leak was based upon the FTM measurement. All studies were performed using a vasoactive agent-redosing schedule. Cavernosography was conducted using a nonionic contrast agent at an intracorporal pressure of 90 mmHg. In patients with an elevated FTM value, 24% had a normal PD recorded, all of whom had FTM values <10 ml/min. The Pearson correlation coefficient for the relationship between FTM and PD was 0.58 (P=0.025). In all, 36 patients (54%) had an abnormal cavernosogram (CG). All patients who had positive findings on CG had elevated FTM values. On the other hand, 46% of patients with abnormal FTM values had a normal CG. This analysis indicates that almost one-half of men with venous leak diagnosed at the time of DIC based on FTM measurement will fail to have any veins visualized on cavernosography. These data further undermine the value of cavernosography, particularly in men with low-grade venous leak.
Mulhall
J P
JP
Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, 525 E. 68th Street, New York, NY 10021, USA. jpm2005@med.cornell.edu
Anderson
M
M
Parker
M
M
D000328:Adult; D006801:Humans; D018783:Impotence, Vasculogenic / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D036502:Infusions, Intralesional; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D010313:Partial Pressure; D012039:Regional Blood Flow; D018608:Ultrasonography, Doppler; D014680:Veins / Q000473:pathology