Venous ligation for cavernous leak impotence--a report on 30 cases

We report our experience with the surgical treatment of 30 patients with venous leak impotence seen at the Division of Urology, Toa Payoh Hospital, over a period from April 1991 to August 1993. The patients were assessed by history, clinical examination, hormonal evaluation and intracavernosal injection of papaverine. Confirmation of venous leak impotence was obtained by pharmaco-cavernosography in all patients; dynamic cavernosometry was performed in the later part of the series. Surgical treatment consisted of ligation and stripping of the deep dorsal vein, ligation of all its emissary and circumflex tributaries for all patients, with crural plication and suspensory ligament re-approximation in selected patients. Peroperative intracavernosal injection of papaverine was used to identify veins and to assess the adequacy of the extent of venous ligation. The mean age of the patients was 40 years. The average operative time was 2 hours. The usual period of hospitalisation was 3 days. Patients were followed up for an average period of 15.6 months. Success was defined as having adequate erections for normal coitus; the success rates at 1, 3, 6, 9 and 12 months were 76.2%, 61.9%, 52.4%, 42.9% and 38.1%, respectively.