1327 SHOULD WE RECONSIDER THE CONCEPT OF VENOUS LEAK? A STUDY OF VENOUS DRAINAGE USING CAVERNO-CT SCAN IN 50 MEN

Field: Medicine (Health Sciences)

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation1 Apr 20111327 SHOULD WE RECONSIDER THE CONCEPT OF VENOUS LEAK? A STUDY OF VENOUS DRAINAGE USING CAVERNO-CT SCAN IN 50 MEN Ronald Virag, Jean-Francois Paul, and Carla Costa Ronald ViragRonald Virag Paris, France More articles by this author , Jean-Francois PaulJean-Francois Paul Plessis Robinson, France More articles by this author , and Carla CostaCarla Costa Porto, Portugal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1147AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Venous leak evaluation remains a challenge in many ED patients. Adequate anatomical evaluation of venous drainage may help to optimize therapeutic strategies. We aim to propose a new classification of venous leakage using multidetector computed tomography (MDCT) cavernography, after intracavernous injection (ICI) of iodinated contrast media, under pharmacological stimulation. METHODS 50 patients (45 with ED, unsatisfied with medical treatment, suspected to have caverno-venous leak; 5 having morphological anomalies, needing surgery) gave informed consent for the study. Patient's clinical history, including age, vascular risk factors, IIEF-5, Penile Nitric Oxide Release test (PNORT), Doppler Ultrasound, previous treatments and the degree of erection (using the erection hardness score, EHS) were evaluated. MDCT consisted in: 1- ICI of a mixture of 1ml of vasoactive medications containing papaverine, chlorydrate (20mg), urapidil chlorydrate (2.75mg) and alprostadil (10mcg) 2-ICI of 20–60 cc of diluted contrast media (1/3) using 20 cc of Ioprimide (300 mg/ml); 3-Spiral MDCT acquisition and 3D volume rendering. Venous drainage was analyzed and identified deep, superficial veins (SV) and caverno-spongious communications, MDCT findings were compared to clinical data. RESULTS Doppler ultrasound suspected venous leak in 84%; PNORT was normal in 52%. The deep dorsal vein (DDV) was opacified in 55% of patients and the SV in 53% of cases. Cavernospongious communications were visible in 20%. 16% presented no visible drainage. A new classification of venous drainage anomalies is proposed from these findings: A-No visible drainage (n=8); B-DDV and preprostatic plexus opacification (n=16); C-Exclusive SV opacification (n=14); D-Opacification of both SV and DDV (n=12). All patients (with one exception) in group A quoted 4 at the EHS vs. none in the others groups (p<0.0001, exact Fisher Test). CONCLUSIONS MDCT after ICI contrast media was able to differentiate between various venous leakage pathways in men with venous origin ED, leading to a new anatomical classification. Absence of leakage was associated with normal erection under pharmacological stimulation. A group of patients with venous leak, no VRF, no endothelial dysfunction and a leak through the superficial veins (group C and D) could be considered for vascular surgery. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e530-e531 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ronald Virag Paris, France More articles by this author Jean-Francois Paul Plessis Robinson, France More articles by this author Carla Costa Porto, Portugal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...