title: Crural ligation for primary erectile dysfunction: a case series.
abstract: OBJECTIVE
  Some men with primary erectile dysfunction (ED) have maldevelopment of the crura of the penis. We report our experience with crural ligation for primary venous leakage ED in the last 5 years.
  
  
  METHODS
  Between December 1998 and March 2004, 11 patients with primary ED underwent crural ligation surgery for congenital venous leakage. All patients were evaluated with pertinent history and physical examinations, color duplex ultrasound, nocturnal penile tumescence study with RigiScan, cavernosometry and cavernosography. Localized crural leakage was the pathognomonic feature in these patients. Surgery involved reflection of the dorsal and cavernous arteries and nerves off of the crura, followed by ligation of the 2 crura proximal to the entrance of the cavernous artery with umbilical tapes. Followup was performed by telephone interview or personal interview at the clinic. A retrospective preoperative and postoperative questionnaire, that is the abridged 5-item version of the 15-item International Index of Erectile Function, was given at the time of the interview. Statistical analysis was performed with the paired t test.
  
  
  RESULTS
  Median patient age at surgery was 28 years (range 22 to 39) and mean followup after surgery was 34 months (range 6 to 58). Mean International Index of Erectile Function +/- SD preoperatively and postoperatively was 8.9 +/- 4.5 and 17.5 +/- 5.0, respectively. For questions 2, 3 and 5 mean postoperative scores were significantly better than postoperative scores (p <0.05). Marked improvement in erectile function was noted in 9 of our 11 patients.
  
  
  CONCLUSIONS
  Penile venous surgery may not have a lasting result in men in whom venous leakage is due to systemic diseases or penile smooth muscle atrophy. However, in patients with a congenital venous leak abnormality of the crura ligation of the proximal crura with umbilical tapes seems to have a satisfactory, durable result.
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California, USA.
authors.forename: Nadeem U
authors.initials: NU
authors.lastname: Rahman
authors.forename: Robert C
authors.initials: RC
authors.lastname: Dean
authors.forename: Rafael
authors.initials: R
authors.lastname: Carrion
authors.forename: Derek
authors.initials: D
authors.lastname: Bochinski
authors.forename: Tom F
authors.initials: TF
authors.lastname: Lue
mesh_terms: D000328:Adult; D006801:Humans; D018783:Impotence, Vasculogenic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008026:Ligation; D008297:Male; D017060:Patient Satisfaction; D010413:Penis / Q000098:blood supply*; D010690:Phlebography; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D014680:Veins / Q000601:surgery