Update on endovascular treatment of venogenic erectile dysfunction

[madman]

We refer to our case report „Venogenic erectile dysfunction: diagnosis on computed tomography cavernosography and endovascular treatment using an anterograde access via deep dorsal penile vein “as recently published in CVIR Endovascular (Hoppe and Diehm 2022).

Supplementary procedural aspects​

With the intention to make this endovascular treatment more easily accessible to endovascular interventionalists, we compiled additional visual material straight from the angiosuite including a movie file to step-by-step demonstrate endovascular treatment of venogenic erectile dysfunction using an anterograde access via a deep dorsal penile vein (Figs. 1, 2, 3 and 4)

Novel procedural aspects​

As previously mentioned, we use a micropuncture set with a 21-G needle, an 0.018-inch guide wire and a stiffened cannula for ultrasound guided deep dorsal penile vein access. Use of a stiffened cannula appears to be more advantageous compared to a floppy cannula due to roughness of the penile fascia (Buck’s fascia). Recently we figured out that a stiff 3-F inner dilator is easier to introduce through the penile fascia into the deep dorsal vein without the 4-F outer catheter. Of interest, there is no relevant impairment of liquid embolic agents’ flow characteristics. This finding is confirmed by previous study results of Palacios et al. demonstrating that 3-F inner dilators are capable of achieving flow rates of at least 6 mL/sec (Palacios et al. 2009).

Future perspective​

However, despite of the promising result of this case report, more scientific evidence is needed regarding endovascular treatment of erectile dysfunction, especially in patients with venous leak. In the meantime, we have treated more than 50 patients for venogenic erectile dysfunction using an endovascular approach with antero-grade access via a deep dorsal penile vein and are currently working on a data analysis and publication of our results in the near future for further clarification.

 

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To the editor-an update on endovascular treatment of venogenic erectile dysfunction - CVIR Endovascular

cvirendovasc.springeropen.com

 

[madman]

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