ERECTILE DYSFUNCTION AND CAVERNOUS VENO-OCCLUSIVE DISEASE

Main Article Content

Ralf Herwig
Ashraf Kamel
Ridwan Shabsigh

Keywords

erectile dysfunction, veno-occlusive diseases

Abstract

Goal
To provide a state-of-the-art literature review on veno-occlusive diseases as a pathomechanism of vasculogenic erectile dysfunction (ED).
Methods
A comprehensive systematic literature search was conducted followed by sorting, review, and summarizing.


Results
The systematic review of the literature reveals a significant number of recent studies dealing with new minimally invasive methods to provide a potential solution of caverno-venous leakage. Even the long-term results reported demonstrate considerable improvement of ED caused by this condition. Furthermore, 3-D computed tomography cavernosography (CT-cavernosography) is a new technology, which can provide high-resolution images of venous drainage from any angle and shows to be very helpful for both the diagnosis of corporal veno-occlusive dysfunction and the anatomical study of the human penile venous system. The application of this technology may also lead to better strategies in venous leak treatment. Over 30 published studies were found in the literature with good results after caverno-venous leak treatment. Altogether, 13 comparable studies including 538 patients were found, in which a mean short-term success rate of almost 80% and a mean long-term success rate of up to 74% was achieved. None of the studies described major complications.
Conclusion
ED is an increasingly important issue, especially in young men. Whereas the current treatment strategies are mostly focused on older men, young patients are seeking more a longer lasting or more definitive solutions, rather than a lifelong medical treatment. Various chronic disorders have been reported to be associated with elevated rates of ED including depression, diabetes, and cardiovascular and neurological disease in older men. Properly selected cases of young men may benefit from treatment of caverno-venous leak treatment. The current strategy in the treatment of ED in young men may be reconsidered.

Downloads

Download data is not yet available.
Abstract 1056 | pdf Downloads 442

References

1. Nguyen HMT, Gabrielson AT, and Hellstrom WJG. Erectile dysfunction in young men-a review of the prevalence and risk factors. Sex Med Rev 2017;5:508–20.
2. Kubin M, Wagner G, and Fugl-Meyer AR. Epidemiology of erectile dysfunction. Int J Impot Res 2003;15:63–71.
3. Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol 2010;57:804–14.
4. Virag R. Indications and early results of sildenafil (Viagra) in erectile dysfunction. Urology 1999;54:1073–77.
5. Rajfer J, Rosciszewski A, and Mehringer M. Prevalence of corporeal venous leakage in impotent men. J Urol 1988;140:69–71.
6. Beidaghian A. The study of venous leakage in erectile dysfunction by cavernosometry and cavernosography: A case series in Sina Hospital; 2001. Available at: tumj.tums.ac.ir
7. Ashdown RR, David JS, and Gibbs C. Impotence in the bull: (1) Abnormal venous drainage of the corpus cavernosum penis. Vet Rec 1979;104:423.
8. Ashdown RR, Gilanpour H, David JS, and Gibbs C. Impotence in the bull: (2) occlusion of the longitudinal canals of the corpus cavernosum penis. Vet Rec 1979;104:598–603.
9. Ashdown RR, Barnett SW, and Ardalani G. Impotence in the boar 2: Clinical and anatomical studies on impotent boars. Vet Rec 1982;110:349–56.
10. Young SL, Hudson RS, and Walker DF. Impotence in bulls due to vascular shunts from the corpus cavernosum penis. J Am Vet Med Assoc 1977;171:643–48.
11. Popken G, Katzenwadel A, and Wetterauer U. Long-term results of dorsal penile vein ligation for symptomatic treatment of erectile dysfunction. Andrologia 1999;31 Suppl 1:77–82.
12. Wespes E, Wildschutz T, Roumeguere T, and Schulman CC. The place of surgery for vascular impotence in the third millennium. J Urol 2003;170:1284–86.
13. Hatzimouratidis K, Giuliano F, Moncada I, et al. EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism.
14. Sohn M, Hatzinger M, Goldstein I, and Krishnamurti S. Standard operating procedures for vascular surgery in erectile dysfunction: revascularization andvenous procedures. J Sex Med 2013;10:172–79.
15. Hellstrom WJ, Montague DK, Moncada I, Carson C, et al. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med 2010;7:501–23.
16. Montorsi F, Adaikan G, Becher E, et al. Summary of the recommendations on sexual dysfunctions in men. J Sex Med 2010;7:3572–88.
17. Virag R. [Unstable erection due to venous insufficiency. Diagnosis and surgical correction. 10 cases with a mean follow-up 12 months (author’s transl)]. J Mal Vasc 1981;6:121–24.
18. Virag R and Bennett AH. Arterial and venous surgery for vasculogenic impotence: a combined French and American experience. Arch Ital Urol Nefrol Androl 1991;63:95–100.
19. Herwig R and Sansalone S. Venous leakage treatment revisited: pelvic venoablation using aethoxysclerol under air block technique and Valsalva maneuver. Arch Ital Urol Androl 2015;87:1–4.
20. Herwig R, Greilberger J, and Weibl P. CT cavernosography and penile venous leak. Conference: EAU 17th Central European Meeting in conjunction with the national 63rd annual conference of the Czech Urological Society (CUS), At Pilsen; 2017.
21. Kawanishi Y, Izumi K, Muguruma H, et al. Three-dimensional CT cavernosography: reconsidering venous ligation surgery on the basis of the modern technology. BJU Int 2011;107:1442–46.
22. Uhl JF. Three-dimensional modelling of the venous system by direct multislice helical computed tomography venography: technique, indications and results. Phlebology 2012;27:270–88.
23. Virag R, and Paul JF. New classification of anomalous venous drainage using caverno-computed tomography in men with erectile dysfunction. J Sex Med 2011;8:1439–44.
24. Cayan S. Primary penile venous leakage surgery with crural ligation in men with erectile dysfunction. J Urol 2008;180:1056–59.
25. Flores S, Tal R, O’Brien K, and Mulhall JP. Outcomes of crural ligation surgery for isolated crural venous leak. J Sex Med 2011;8:3495–99.
26. TF. Surgery for crural venous leakage. Urology 1999;54:739–41.
27. Mulhall JP, Martin D, Ergin E, and Kim F. Crural ligation surgery for the young male with venogenic erectile dysfunction: technique. Tech Urol 2001;7:290–93.
28. Puech-Leão P, Reis JM, Glina S, and Reichelt AC. Leakage through the crural edge of corpus cavernosum. Diagnosis and treatment. Eur Urol 1987;13:163–65.
29. Rahman NU, Dean RC, Carrion R, et al. Crural ligation for primary erectile dysfunction: a case series. Elsevier; 2005.
30. Basche S, Eger C, Elsebach K, and Ulshöfer B. [Veno-occlusive dysfunction as a cause of erectile impotence: therapy of venous leak with retrograde embolization of the internal pudendal vein]. Vasa 2003;32:47–50.
31. Hsu G-L, Hill JW, Hsieh CH, et al. Venous ligation: a novel strategy for glans enhancement in penile prosthesis implantation. BioMed Res Internat;2014.
32. Vale JA, Feneley MR, Lees WR, and Kirby RS. Venous leak surgery: long-term follow-up of patients undergoing excision and ligation of the deep dorsal vein of the penis. Br J Urol 1995;76:192–95.
33. Chen SC, Hsieh CH, Hsu GL, et al. The progression of the penile vein: could it be recurrent. J Androl 2005;26:53–60.
34. Zhang B, Chen J Xiao H, et al. Treatment of penile deep dorsal venous leakage of erectile dysfunction by embedding the deep dorsal vein of the penis: a single center experience with 17 patients. J Sex Med 2009;6:1467–73.
35. Kutlu R. Deep dorsal vein embolization with N-butyl-2-cyanoacrylate and lipiodol mixture in venogenic erectile dysfunction: early and late results. Sciendo 2009;43:1. Available at: degruyter.com
36. Miwa Y, Shioyama R, Itou Y, et al. Pelvic venoablation with ethanol for the treatment of erectile dysfunction due to veno-occlusive dysfunction. Urology 2001;58:76–79.
37. Nakata M, Takashima S, Kaminou T, et al. Embolo-therapy for venous impotence: use of ethanol. J Vasc Interv Radiol 2000;11:1053–57.
38. Peşkircioğlu L, Tekin I, Boyvat F, et al. Embolization of the deep dorsal vein for the treatment of erectile impotence due to veno-occlusive dysfunction. J Urol 2000;163:472–75.
39. Sangiorgi G, Colantonio R, Antonini G, et al. [Percutaneous intervention therapy for vascular erectile dysfunction]. G Ital Cardiol (Rome) 2016;17:12S–121.
40. Schild HH, Müller SC, Mildenberger P, et al. Percutaneous penile venoablation for treatment of impotence. Cardiovasc Intervent Radiol 1993;16:280–86.
41. Schild HH and Muller SC. Retrograde penile venoablation. Ann Acad Med Singapore 1993;22:675–78.
42. Schild HH, Müller SC, Hermann M, et al. [Penile venous outflow occlusion: a comparison of erectile function and cavernosometry before and after percutaneous interventions]. Rofo 1993;158:59–61.
43. Schild HH, Müller SC, Mildenberger P, et al. [Retrograde venous occlusion-- therapy of impotence of venous origin]. Rofo 1993;158:238–41.
44. Campbell B. Varicose veins and their management. BMJ 2006;333:287–92.
45. Redondo P, and Cabrera J. Microfoam sclerotherapy. Semin Cutan Med Surg 2005;24:175–83.
46. Herwig R, Margreiter M, and Kuehhas F. C22 pelvic venoablation for the treatment of erectile dysfunction caused by venous leakage. Eur Urol Suppl 2012;11:87.
47. Carrino M, Pucci L, Chiancone L, et al. Embolization of the deep dorsal vein using aethoxysklerol in the treatment of erectole dysfunction resulting from venous leakage. Analysis of our experience with 171 patients. XXIII Congresso Nationale Auro.it; March 2016.
48. Xu CC, Pan YN, and Tang YF, et al. Comprehensive assessment of cavernosography with 320-row dynamic volume CT versus conventional cavernosography in erectile dysfunction patients caused by venous leakage. Biosci Rep 2017;37(3).
49. Keller JJ and Lin HC. Haemorrhoids are associated with erectile dysfunction: a population-based study. Int J Androl 2012;35:867–72.
50. Pilkington SA, Bateman AC, Wombwell S, and Miller R. Anatomical basis for impotence following haemorrhoid sclerotherapy. Ann R Coll Surg Engl 2000;82:303–306.
51. Rebonato A, Maiettini D, Ceccherini C, et al. Endovascular treatment of recurrent erectile dysfunction due to venous occlusive disease. Asian J Androl 2017;19:509–10.
52. Aschenbach R, Steiner T, Kerl MJ, et al. Endovascular embolisation therapy in men with erectile impotence due to veno-occlusive dysfunction. Eur J Radiol 2013;82:504–507.
53. Rebonato A, Auci A, Sanguinetti F, et al. Embolization of the periprostatic venous plexus for erectile dysfunction resulting from venous leakage. J Vasc Interv Radiol 2014;25:866–72.