Penile venous surgery in impotence: results in highly selected cases

Currently, indications for penile venous surgery are dynamic pharmacocavernosographic findings in impotent patients who fail to respond to intracorporeal application of vasoactive substances and who demonstrate unimpaired arterial perfusion. We used pharmacocavernosometry to measure penile intracorporeal maintenance flow rate in 48 impotent men: 20 had maintenance flow rates higher than 30 ml/min, 12 of the 20 had leakage mainly via Santorini's plexus. In 7 of this 12, venous ligation procedures were initially successful, and in 6 of them erectile function returned. After a mean follow-up, seven of the 12 eventually had to be treated with penile implants. Another 4 used self-injection of prostaglandin E1; only 1 patient reported spontaneous erections sufficient for intercourse. Poor long-term results of surgery and recent data on active mechanisms in venous outflow restriction raise doubts as to whether penile venous surgery can ever cure so-called venous incompetence.