Nonsurgical treatment of cavernosal venous leakage

To evaluate the results of treating patients with cavernosal venous leakage (CVL) with polyagent self-administered intracavernous pharmacotherapy and vacuum constriction devices (VCDs).

One hundred eighty-eight chronically impotent patients with a mean age of 58.8 years were studied. This group comprised 103 patients treated with standard-dose and high-dose polyagent self-administered intracavernous pharmacotherapy and 85 patients treated with a VCD. The erectile response was related to the severity of CVL (mild, moderate, and severe).

With standard polyagent pharmacotherapy, a response sufficient for satisfactory intercourse was achieved in 18 of 32 patients with mild CVL, 9 of 54 patients with moderate CVL, and in 0 of 17 patients with severe CVL. With high-dose polyagent pharmacotherapy, a response sufficient for satisfactory intercourse was achieved in 22 of 32 patients with mild CVL, 29 of 54 patients with moderate CVL, and in 2 of 17 patients with severe CVL. With a VCD, a response sufficient for satisfactory intercourse was achieved in 23 of 30 patients with mild CVL, 24 of 40 patients with moderate CVL, and in 10 of 15 patients with severe CVL.

CVL of mild to moderate severity can be treated with polyagent pharmacotherapy and VCDs with reasonable expectations of success. Severe CVL responds poorly to polyagent pharmacotherapy but can be treated with VCDs with reasonable results in motivated, adequately instructed patients.