[Impotence with venous leakage. An extensive study of 49 cases detected by the artificial erection test]

Fourty nine men seeking advice for erectile impotence, in whom the serum flow rate necessary to maintain an artificial erection (MFR) exceeded the upper limit of the normal range proposed by most authors (75 ml/mn), underwent different investigations (including a study of their penile arteries, Nocturnal Penile Tumescence monitoring (NPT) and a papaverine test) in order to ascertain the organic basis of their impotence, and to define the diagnostic criteria for "venous incompetence". Several other types of treatments were attempted. Two thirds of the patients were found to have occlusions of their sexual arteries, and these were severe in one third of cases. Our overall results suggest that only cases of MFR exceeding 120 ml per mn. were due to a true organic abnormality (severe venous incompetence, SVI), able to induce impotence, and possibly warrant surgical treatment, on condition that the organic nature is confirmed by NPT. 40% of the cases of impotence with SVI start before the age of 40, and 15% are primary. 37.5% of the cases never achieve rigid erection, and 37.5% have only rigid erections of short duration. Very few plausible etiological factors were found, except fibrosis of the cavernous bodies in 5 cases. The prognosis of impotence with SVI seems very bad, since only 4 of the 35 patients were clearly improved by non surgical treatments, while only 1 out of the 10 patients who underwent a surgical ligation of the deep dorsal vein of the penis was improved.