Ligation and Embolization in One Procedure for Cavernovenous Leakage in 171 Patients with Drug-Resistant Erectile...

Assess results of simultaneous ligation and embolization for cavernovenous leakage (CVL) in patients with erectile dysfunction (ED) resistant to Phosphodiesterase-5 inhibitors.

Data from consecutive patients with ED operated-on for CVL, were collected prospectively. CVLs were diagnosed by Pharmacologically Challenged Penile Duplex Sonography (PC-PDS) and computed tomography cavernosography. Patients underwent open surgical ligation and endovascular embolization during the same procedure. The main exclusion criterium was any other untreated organic cause of ED, and for embolization high risk of thromboembolic complication. Primary endpoints were (1) 3-month Pharmacologically Challenged Erection Hardness Score (PC-EHS) and (2) end-of-follow-up clinical EHS. Secondary endpoints were (1) PC-PDS parameters and (2) International Index of Erectile Function, domain 5 score (IIEF-5). Statistical analysis used paired Student's t-test, t-test of means and Chi-square test.

Of the patients, 171 underwent treatment. Mean follow-up was 22.88 ± 19.71 months. Twenty-four patients (14.0%) underwent vascular reoperation for persisting ED and CVL at 3 months. Mean PC-EHS increased from 2.56 ±0 .66 to 3.40 ± 0.56 (P < 0.0001). The proportion of patients with a PC-EHS<3 dropped from 64.9 to 11.2% (Chi-square: P < 0.001). All PC-PDS parameters had decreased significantly. At the end-of-follow-up, mean clinical EHS increased significantly during morning erections (from 0.95 ± 1.24 to 2.12 ± 1.37), masturbation (from 2.11 ± 0.67 to 3.04 ± 0.75), sexual intercourses (from 1.94 ± 0.67 to 3.31 ± 0.75) (P < 0.0001 for all criteria), and mean IIEF-5 score from 10.68 ± 5.11 to 15.89 ± 5.80 (P < 0.0001). Nine (5.29%) experienced a decreased PC-EHS. End-of-follow-up erection improvement rate was 80.7%.

CVL can be treated effectively with combined open and endovascular techniques. Accurate preoperative assessment and 3-month hemodynamic evaluation are essential.