Long-term results of the veno-occlusive percutaneous treatment of erectile disorders of venous origin

The treatment of impotence due to venous leakage is remedied by creating an
increase in the resistance of the venous outflow in order to trap arterial blood
within the corpora cavernosa of the penis during erection. The percentage of
success reported in Literature after resection of the deep dorsal vein and
ligature of the cavernous veins varies from a minimum of 12.5% to a maximum of
75%. Interventional radiology represents a valid alternative to traditional
surgery in the non-prosthesis treatment of erectile dysfunction of venous origin
due to the absence of complications and lack of intrusiveness and for the
encouraging short and mid term results obtained. From May 1991 to February 1997,
seventeen patients (aged between 24-54, average age 36 years) affected by venous
leakage underwent embolisation of the principal veins of drainage of the corpora
cavernosa. All patients were previously strictly selected in order to exclude
those affected by arterial, neurological, endocrine or ++psychological disease.
Pathologic venous drainage was shown by pharmacocavernosometry and
pharmacocavernosography. The technique employed consisted in isolation and
catheterization of the deep dorsal vein of the penis with a cannula needle of 14
G and subsequent ligature and simple section of the vein; venous leakage
fluoroscopic evaluation; coils placement under radiological control, in the
distal tract of each vein chosen to be occluded; and then at last, embolization
of the deep dorsal vein. A fluoroscopic control performed after these procedures
showed the correct vascular occlusion. The operation has an average duration of
120 minutes and requires two-day hospitalisation. In 12% (2/17) of the selected
cases a technical failure was recorded due to difficult catheterization of the
periprostatic plexus, therefore only surgical ligature and section was carried
out in the penile deep dorsal vein. Only in one case (6%) there was a slight and
transitory oedema of the penis observed. The average follow-up is 34 months
(range 3-72 months). Up to now, 11 patients over 15 (73.4%) refer a good
improvement of erectile dysfunction together with a satisfactory sexual activity.
In two cases (13.3%) only partial improvement have been referred. Only 2 cases
(13.3%) did not obtain any benefit from treatment.