title: Venous leakage treatment revisited: pelvic venoablation using aethoxysclerol under air block technique and Valsalva maneuver.
abstract: OBJECTIVE
  We evaluated the effectiveness of pelvic vein embolization with aethoxysclerol in aero-block technique for the treatment of impotence due to venous leakage in men using sildenafil for intercourse. The aim of the procedure was to reduce the use of sildenafil.
  
  
  METHODS
  A total of 96 patients with veno-occlusive dysfunction, severe enough for the need of PDE5 inhibitors for vaginal penetration, underwent pelvic venoablation with aethoxysclerol. The mean patient age was 53.5 years. Venous leaks were identified by Color Doppler Ultrasound after intracavernous alprostadil injection. Under local anesthesia a 20-gauge needle was inserted into the deep dorsal penile vein. The pelvic venogram was obtained through deep dorsal venography. Aethoxysclerol 3% as sclerosing agent was injected after air-block under Valsalva manoeuver. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Additionally, a pre- and post- therapy IIEF score and a digital overnight spontaneous erections protocol (OSEP) with the NEVA™-system was performed.
  
  
  RESULTS
  At 3 month follow-up 77 out of 96 patients (80.21%) reported to have erections sufficient for vaginal insertion without the use of any drug or additional device. Four (4.17%) patients did not report any improvement. Follow up with color Doppler ultrasound revealed a new or persistent venous leakage in 8 (8.33%) of the patients. No serious complications occurred.
  
  
  CONCLUSIONS
  Our new pelvic venoablation technique using aethoxysclerol in air-block technique was effective, minimally invasive, and cost-effective. All patients were able to perform sexual intercourse without the previously used dosage of PDE5 inhibitor. This new method may help in patients with contra-indications against PDE5 inhibitors, in patients who cannot afford the frequent usage of expensive oral medication or those who do not fully respond to PDE5-inhibitors.
authors.affiliation: Vienna International Medical Clinic, Department of Urology. dr.ralf.herwig@gmail.com.
authors.forename: Ralf
authors.initials: R
authors.lastname: Herwig
authors.forename: Salvatore
authors.initials: S
authors.lastname: Sansalone
mesh_terms: D000328:Adult; D000368:Aged; D000388:Air; D001317:Austria; D000075202:Contraindications; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D018783:Impotence, Vasculogenic / Q000175:diagnosis / Q000191:economics / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007558:Italy; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects; D010413:Penis / Q000098:blood supply*; D010690:Phlebography / Q000379:methods; D058986:Phosphodiesterase 5 Inhibitors / Q000008:administration & dosage / Q000191:economics; D010879:Piperazines / Q000008:administration & dosage / Q000191:economics; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000191:economics; D011687:Purines / Q000008:administration & dosage / Q000191:economics; D011788:Quality of Life; D012597:Sclerosing Solutions / Q000008:administration & dosage* / Q000191:economics; D012720:Severity of Illness Index; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000008:administration & dosage / Q000191:economics; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D014636:Valsalva Maneuver; D020246:Venous Thrombosis / Q000150:complications / Q000191:economics / Q000628:therapy*
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D010879:Piperazines; D011687:Purines; D012597:Sclerosing Solutions; D013449:Sulfonamides; D000077423:Polidocanol; D011092:Polyethylene Glycols; D000068677:Sildenafil Citrate