Erectile impotence due to veno-occlusive dysfunction:: Therapy of the venous leckage with retrograde embolisation of vena pudenda interna

Venous leak impotence" remains a therapeutic challenge as long term success rates with all interventions are only 50%. Surgical venous ligation is a well established procedure, yet not all pathological venous groups can always be occluded. Retrograde embolisation of angiographically identified pathological venous groups represent a promising alternative to surgical isolation and antegrad embolisation of deep dorsal penile veins. Four young men (19-42 years) presented with complete loss of erection. Vaginal intercourse was impossible. Pharmaco-duplex sonography with Prostaglandin E, 10-20 mug demonstrated normal arterial flow in all 4 penile arteries but even after intra-cavernosal injection of Prostaglandin E, 20 mug no complete erection was achieved. Dynamic infusion cavernosometry showed increased maintainance flow. Cavernosography showed a venous leak involving the deep dorsal penile vein in all four cases. Embolisation was carried out via the femoral vein by coaxial technique using Histoacryl-Lipiodol solution in order to embolise all angiographically identified insufficient veins. At one year follow up all 4 patients still achieved spontaneous erections without any additional medical treatment.