(157) Primary Erectile Dysfunction Caused by Cavernovenous Leakage: Clinical Presentation and New Surgical Treatment in 81 Consecutive Patients with Severe Erectile Dysfunction
Authors: Allaire E , Pedini M , Maman-Maharazou M , Sussman H , Floresco J , Hauet P , Virag R 
Published: March 2024

Abstract

Introduction
Introduction. Primary erectile dysfunction (PED) due to cavernovenous leakage (CVL), a disease in which blood entering corpora cavernosa escapes too early because of abnormal venous network, may affect as many as 1 to 2% of men under 30 with failure of erections to develop or maintain. When resistant to PDE5Is, it is a devastating condition leaving men with no possibility of sexual intercourse with penetration, and usually absence of diagnosis and specific treatment.

Objective
Evaluate symptoms and results of a new method of treatment combining open surgery and embolization simultaneously during the same procedure, in patients with PED and CVL resistant to PDE5Is.

Methods
81 consecutive patients with severe PED with CVL diagnosed by pharmacologically-challenge penile duplex sonography (PC-PDS) were operated-on. Leaks were imaged by caverno-computed tomography. Patients with other cause of ED were excluded, all had refused a penile implant, signed an informed consent, had a control PC-PDS three months after surgery, and were clinically evaluated during follow-up. A retrospective analysis was performed on prospectively collected data. Comparisons of variables before and after surgery used a paired t-test.

Results
Mean age at PED onset reported by patients was 19.0±4.6 years, range 13–30. Mean age at surgery was 34.5±9.2 years, range 18–70. Mean ED duration before surgery was 15.4±10.1 years (range 1–40). All patients had clinical signs of organic ED (no phase of erection improvement in the past six months, erectile dysfunction during masturbation (Erection Hardness Score (EHS)&lt;3 and/or erection instability). CVL could be suspected in all patients based on reported erection instability during masturbation, and in 86.4%, based on variation of EHS according to body position during masturbations. At three-month evaluation, mean pharmacologic EHS had increased from 2.59±.77 before surgery, to 3.45±.63 (p&lt;.0001). The mean pharmacologic EHS increase was 0.83±.92. All CVL hemodynamic parameters at PC-PDS had decreased compared to pre-surgery: mean End Diastolic Velocity (from 9.9±9.22 to 6.77±7.34 cm/s, p&lt;.023), mean leakage speed on Deep Dorsal Vein (from 10.87±12.48 to .69±2.77 cm/s, p&lt;.0001), mean speed on any superficial vein (from 10.96±10.08 to 4.77±6.90 cm/s, p&lt;.0001). Patients unable to perform penetrations despite intracavernous injection of Prostaglandin E1 20 micg plus Papaverine 40 mg (pharmacological EHS&lt;3) decreased from 64.2 to 13.5% (Chi-square test: p&lt;.001). At the end of the 26.0±21.9-month follow-up, IIEF-5 score had increased from 8.9±5.3 to 16.1±5.8 (p&lt;.013), clinical EHS during sexual intercourse from 1.97±.67 to 3.31±.71 (p&lt;.0001), penetration success rate from 18.3±28.2 to 64.2±40.1%, morning EHSfrom 1.11±1.40 to 2.12±1.49 (p&lt;.0002), masturbation EHS from 2.14±.84 to 3.07±.77 (p&lt;.002) before and after surgery, respectively. 38.3% did not take any medication for erection.

Conclusions
Simultaneous open surgery and embolization is a conservative treatment that should be discussed for patients with PED and CVL. PED can be suspected during consultation. Detection of CVL in all patients under 30 with ED should be evaluated in sexual medicine practice.

Disclosure
No.