Assess results of simultaneous ligation and embolization for caverno-venous leakage (CVL) in patients with erectile dysfunction (ED) resistant to 5-Phosphodiesterase inhibitors.
Data from consecutive patients with ED operated-on for CVL, were collected prospectively. CVLs were diagnosed by Pharmacologicaly-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 thrombo-embolic complication. Primary endpoints were: 1. Three-month Pharmacologicaly-Challanged Erection Hardness Score (PC-EHS), 2. End-of-follow-up clinical EHS. Secondary endpoints were: 1. PC-PDS parameters, 2. International Index of Erectile Function, domain 5 score (IIEF-5). Statistical analysis used paired Student t-test, T-test of means and Chi-2 test.
171 patients underwent treatment. Mean follow-up was 22.88±19.71 months. Twenty-four patients (14.0 %) underwent vascular re-operation for persisting ED and CVL at three months. Mean PC-EHS increased from 2.56±.66 to 3.40±0.56 (p<.0001). The proportion of patients with a PC-EHS<3 dropped from 64.9 to 11.2% (Chi-2: p<.001). All PC-PDS parameters had decreased significantly. At the end-of-follow-up, mean clinical EHS increased significantly during morning erections (from .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<.0001 for all criteria), and mean IIEF-5 score from 10.68±5.11 to 15.89±5.80 (p<.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 three-month hemodynamic evaluation, are essential.
Annals of vascular surgery. 2025 Sep 03 [Epub ahead of print]
Eric Allaire, Pascal Hauet, Jean Floresco, Christophe Crul, Ronald Virag, Hélène Sussman
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