Die dorsale Penisvenenligatur zur Therapie des venösen Lecks bei erektiler Dysfunktion

Dynamic cavernosography as a means to test coital impotence

In our days the radiologic examination method of dynamic cavernosography is still in the state of infancy but has already passed the test as an indispensable means to locate the site of a venous leak and to diagnose other pathologic penile conditions. Its field of application covers penile fracture, the extension of induratio penis plastica, the degree of fibrosis in the postpriapic state, the testing of tumour penetration. The method being invasive it is important to apply it in the proper diagnostic order, as soon as clear proof has been furnished that the potency disorder is not due to impaired reflex activity, has not developed on a psychic background and the Doppler test has revealed normal arterial flow conditions.

Surgical treatment of impotence due to venous outflow

Coital impotence was studied in 94 patients. In 14 of them the history, as well as the papaverine-induced erection, penile Doppler test and dynamic cavernosography suggested venous outflow as a basic process. In 13 who underwent surgery, the draining vein visualized by dynamic cavernosography was tied down. Seven patients now have spontaneous erection, four present it upon intravenous papaverine injection. Two operations failed: one for an existent spongiocavernous fistula, the other for the development of collateral circulation in the early phase.

Venous surgery in erectile dysfunction: a critical report on 116 patients

From June, 1985, to December, 1987, we operated on 116 impotent patients suffering from venous incompetence of the cavernous bodies. A total of 115 patients underwent ligation of the deep dorsal vein of the penis. After a mean follow-up of 12.9 months, 67 patients (58.3%) were still able to obtain satisfactory erections. In 39 cases (33.9%), however, adjuvant corpus cavernosum autoinjection therapy was necessary. Eleven patients were submitted to spongiosolysis after ligation of the deep dorsal penile vein because of a distal venous leakage, consisting of venous shunts between the corpora cavernosa and the corpus spongiosum. After a mean follow-up of 14.2 months, 9 patients (81.8%) reported excellent penile rigidity; 5 of these patients, however, needed corpus cavernosum autoinjection therapy to maintain erectile function. One patient with ectopic veins emerging from the right crus of the penis was operated on successfully from a perineal approach. Serious complications did not occur in any of the patients. Despite the recurrence rate of 13 percent, venous surgery is an effective treatment for most patients concerned and offers a more physiologic erectile function than can be achieved by implantation of a penile prosthesis.