Penile Vein Ligation Research Articles

Long-term results of dorsal penile vein ligation for symptomatic treatment of erectile dysfunction.

About 20% of patients with erectile dysfunction do not react to intracavernous pharmacological treatment (SKAT) because of a cavernous leak. The first attempt to treat venous insufficiency goes back as far as the beginning of the century. Ligature and resection of the superficial and deep veins of the penis (DPVL) were performed in 122 patients (nonresponders to SKAT with a maintenance flow of less than 40 ml min-1). Twenty-four patients suffered from primary dysfunction and 98 from secondary dysfunction. The average age of the patients was 49 years, and the average duration of the preoperative erectile dysfunction 4.4 years. Postoperative follow-up was carried out for 70 months. In 98% of the patients, cavernosography revealed a dorsal leak. Twenty-six per cent had ectopic veins, 38% a leakage through the crural veins and 24% a glandular or spongiosal shunt. After the 70-month follow-up, only 14% of the 122 patients were able to achieve an adequate spontaneous erection and 19% also responded to SKAT. Depending upon the time elapsed since the operation, the rate of spontaneous reaction was reduced. It was found that younger patients with a short history of erectile dysfunction, no arterial cofactor, a maintenance flow of less than 100 ml min-1 and a severe dorsal leakage from a DPVL were the most likely to benefit from this procedure. Since degeneration of smooth muscle cells of the cavernosa is in most patients the cause of the venous leakage, penis vein surgery is to be regarded as symptomatic treatment.

Is dorsale penile vein ligation (dpvl) still a treatment option in veno-occlusive dysfunction?

To determine the long-term results of the DPVL for the treatment of venous impotence. The long term results of DPVL in 134 patients were interviewed. The mean age was 39.2 (range 21-72). Power color doppler imaging, pharmacocavernography/dynamic cavernosometry were performed. Postoperatively, all the patients were controlled in the 6th month, first year and, if possible, once a year. The mean follow-up was 54.8 (14-76) months. Postoperative outcomes were classified into three groups: complete spontaneous erection (CR), response to pharmacotherapy (PR) or no satisfactory improvement (NR). The short-term success in the 6th month according to above mentioned was 38.8%, 18.6% and 42.5%; and in the first year was 19.4%, 14.9% and 65.6% respectively. The result in 35 patients whose follow-up was at least 5 years (mean 67 months) was 11.4%, 14.3% and 74.3% respectively. Positive prognostic factors were preoperative age <40, duration of erectile dysfunction <2 years, non-smoker patients, non neurogenic disease and distal disease. With all these parameters present, long-term success (CR, PR) rose from 33.6% to 55.9% (P < 0.001). Long-term success for unselected patients undergoing DPVL is disappointing; however, careful patient selection significantly improves long-term results.

Penile blunt trauma induced veno-occlusive erectile dysfunction.

Blunt trauma to the pelvic or perineal region of the corpora cavernosa is a risk factor for the subsequent development of persistent erectile dysfunction. The hemodynamic investigation of the integrity of the veno-occlusive mechanism has been rare in cases of traumatic impotence. We present two young men with erectile dysfunction following blunt penile or perineal trauma. Combined intracavernous injection and stimulation test, color duplex ultrasonography, and pharmacologic cavernosometry and cavernosography revealed normal arterial velocity and pulsation without cavernosal arterial fistula, but severe venous occlusion and site-specific abnormal veins were noted in both patients. They received penile vein ligation procedure and resulted in near-completely normal erectile function after a four-year followup. Penile venous ligation, especially on the site-specific veins, is still the choice of treatment for the trauma-induced penile veno-occlusive erectile dysfunction, and the result is satisfactory.

Is dorsale penile vein ligation (DPVL) still a treatment option in veno-occlusive dysfunction?

To determine the long-term results of the DPVL for the treatment of venous impotence. The long-term results of DPVL in 134 patients were interviewed. The mean age was 39.2 (range 21-72). Power color doppler imaging, pharmacocavernography/dynamic cavernosometry were performed. Postoperatively, all the patients were controlled in the 6th month, first year and, if possible, once a year. The mean follow-up was 54.8 (14-76) months. Postoperative outcomes were classified into 3 groups: complete spontaneous erection (CR), response to pharmacotherapy (PR) or no satisfactory improvement (NR). The short-term success in the 6th month according to above mentioned was 38.8%, 18.6% and 42.5%; and in the first year was 19.4%, 14.9% and 65.6% respectively. The result in 35 patients whose follow-up was at least 5 years (mean 67 months) was 11.4%, 14.3% and 74.3% respectively. Positive prognostic factors were preoperative age <40, duration of erectile dysfunction <2 y, non-smoker patients, non neurogenic disease and distal disease. With all these parameters present, long-term success (CR, PR) rose from 33.6% to 55.9% (p < 0.001). Long-term success for unselected patients undergoing DPVL is disappointing; however, careful patient selection significantly improves long-term results.

Long-Term Results Following Dorsal Penile Vein Ligation in 126 Patients With Veno-Occlusive Dysfunction

Long-Term Results Following Dorsal Penile Vein Ligation in 126 Patients With Veno-Occlusive Dysfunction

Long-Term Results Following Dorsal Penile Vein Ligation in 126 Patients With Veno-Occlusive Dysfunction

No AccessJournal of UrologyUrological Survey: Abstracts: Sexual Function and Dysfunction1 Aug 1998Long-Term Results Following Dorsal Penile Vein Ligation in 126 Patients With Veno-Occlusive Dysfunction D. Schultheiss, M.C. Truss, A.J. Becker, C.G. Stief, and U. Jonas D. SchultheissD. Schultheiss More articles by this author , M.C. TrussM.C. Truss More articles by this author , A.J. BeckerA.J. Becker More articles by this author , C.G. StiefC.G. Stief More articles by this author , and U. JonasU. Jonas More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62986-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Long-Term Results Following Dorsal Penile Vein Ligation in 126 Patients With Veno-Occlusive Dysfunction." The Journal of Urology, 160(2), p. 626 Department of Urology, Medizinische Hochschule Hannover, Hannover, Germany© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 160Issue 2August 1998Page: 626 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.MetricsAuthor Information D. Schultheiss More articles by this author M.C. Truss More articles by this author A.J. Becker More articles by this author C.G. Stief More articles by this author U. Jonas More articles by this author Expand All Advertisement PDF DownloadLoading ...

Long-term results following dorsal penile vein ligation in 126 patients with veno-occlusive dysfunction.

One hundred and forty-seven patients who had dorsal penile vein ligation (DPVL) between 1987 and 1996 were re-investigated either during clinical consultation or by standardised telephone interview respectively questionnaire. One hundred and twenty-six patients were available for long-term follow-up. Postoperative outcome was classified into complete spontaneous erection, postoperative response to pharmacotherapy or no satisfactory improvement. The short-term success after 1-3 months according to this classification was 31 (24.6%), 25 (19.8%) and 70 (55.6%). These results were found to have deteriorated on long-term observation; with only 14 (11.2%), 24 (19.0%) and 88 (69.8%) respectively. Positive prognostic factors were preoperative duration of erectile dysfunction of < or = 7 y, a normal CC-EMG and a maintenance flow of < or = 45 ml/min. With all three parameters present, longterm success (spontaneous erection plus responder to intracavernous injection) rose from 30 to 67% in this selected group (P < or = 0.001). Our study shows that long-term success for unselected patients undergoing DPVL is disappointing; however, careful patient selection significantly improves long-term results.

Penile venous surgery – prognostic factors and long-term results

Poor longterm success has been reported for penile vein ligation the last few years. Therefore, we decided to re-investigate our group of 147 patients who were operated on between 1987 and 1996. All patients showed a negative response to intracavernous injection therapy at the time of diagnosis and revealed a maintenance flow > 15 ml/min, as well as a pathological venous flow with pharmacocavernosometry or pharmacocavernosography. These patients underwent ligation of all superficial dorsal veins and resection of the deep dorsal vein of the penis. An up-to-date record of the success of the operation was kept either by a renewed clinical visit or by a standardized telephone interview or questionnaire. A total of 126 patients were available here for long-term follow-up. We divided the findings into three groups: complete spontaneous erection, postoperative response to cavernous autoinjection therapy and no changes in erectile competency postoperatively. The short-term success rate for these groups after 1-3 months was an outcome of 31 (24.6%), 25 (19.8%) and 70 (55.6%) patients; 86% of the cases whose results deteriorated after the initial operation success rate had this happen within the first postoperative year (p < or = 0.001). Favorable prognostic factors were preoperative erectile dysfunction of < or = 7 years, a normal CC-EMG and a maintenance flow of < or = 45 ml/min. If all three parameters were present, the long-term success rate (spontaneous erection plus response to intracavernous injection) of 30% of all patients was found to rise to 67% in this selected group of patients (p < or = 0.001). This study reveals that long-term success for unselected patients undergoing penile venous surgery is disappointing; however, careful selection of patients by certain prognostic factors can improve long-term results.

Doppler sonography in the evaluation of corporovenous competence after penile vein ligation surgery.

Doppler ultrasonographic findings in patients after penile vein ligation surgery are described and compared to the results of cavernosometry and cavernosography. Peak systolic and end diastolic velocities were recorded for both cavernosal arteries at 5 min intervals after papaverine injection for a total of 30 min. Peak end diastolic flow rates were compared with cavernosometric and cavernosographic results at 0-10 min, 11-20 min, and 21-30 min. Cavernosography identified venous leakage in nine patients. The end diastolic velocities were greater than the 5 cm/s threshold level generally considered to be indicative of venous leakage in nine of the nine patients (100%) at 0-10 min, in eight of the nine (89%) at 11-20 min, and in nine of the nine (100%) at 21-30 min. Although peak end diastolic velocities at or near the 5 cm/s threshold could be found in patients both with and without recurrent venous leakage in the initial 10 min of the studies, only patients with recurrent venous leakage had diastolic velocities that exceeded the 5 cm/s level when measured 10 min or more after injection. Measurement of end diastolic velocities between 21 and 30 min after injection seemed to discriminate most effectively the patients with recurrent venous leakage from those without leakage in the postoperative population.

Long-Term Results With Penile Vein Ligation for Venogenic Impotence

Penile vein ligation for venogenic impotence was performed on 15 patients between 1989 and 1992. Preoperative evaluation included color flow Doppler ultrasound, and dynamic infusion cavernosogram and cavernosometry with vasoactive substance injection. All operations were performed by 1 surgeon via an inguinoscrotal incision by excising the deep dorsal, cavernous and, if necessary, crural veins. All patients were interviewed using a structured telephone questionnaire from 19 to 45 months (mean 29) postoperatively. Postoperative potency was defined as erections sufficient for unaided coitus on more than 75% of attempts and was present in 9 patients (60%). The 2 failures had temporary improvement within the first 6 months. The only significant preoperative variable in assessing postoperative potency was the duration of erectile dysfunction before penile vein ligation: median 60 months (range 48 to 120) in the impotent group and median 24 months (range 12 to 168) in the potent group (p < 0.05, Mann-Whitney test). No correlation was found with systolic and diastolic arterial flow or resistive index as assessed by color flow Doppler evaluation, sites of leakage or patient age at operation. Similarly, no correlation was found with preoperative dynamic infusion cavernosometry maintenance rates. The most common complication was contracture of the penis in 6 patients (40%), although only 1 complained of a functional disturbance. We demonstrated favorable long-term results with an extensive venous ligation. While preoperative assessment with color flow Doppler ultrasound, dynamic infusion cavernosography and cavernosometry, and vasoactive substance injection establishes a diagnosis of corporeal veno-occlusive dysfunction, this evaluation provides no predictive indicators for successful outcomes in penile vein ligation.

Long-Term Results With Penile Vein Ligation for Venogenic Impotence

Penile vein ligation for venogenic impotence was performed on 15 patients between 1989 and 1992. Preoperative evaluation included color flow Doppler ultrasound, and dynamic infusion cavernosogram and cavernosometry with vasoactive substance injection. All operations were performed by 1 surgeon via an inguinoscrotal incision by excising the deep dorsal, cavernous and, if necessary, crural veins. All patients were interviewed using a structured telephone questionnaire from 19 to 45 months (mean 29) postoperatively. Postoperative potency was defined as erections sufficient for unaided coitus on more than 75% of attempts and was present in 9 patients (60%). The 2 failures had temporary improvement within the first 6 months. The only significant preoperative variable in assessing postoperative potency was the duration of erectile dysfunction before penile vein ligation: median 60 months (range 48 to 120) in the impotent group and median 24 months (range 12 to 168) in the potent group (p < 0.05, Mann-Whitney test). No correlation was found with systolic and diastolic arterial flow or resistive index as assessed by color flow Doppler evaluation, sites of leakage or patient age at operation. Similarly, no correlation was found with preoperative dynamic infusion cavernosometry maintenance rates. The most common complication was contracture of the penis in 6 patients (40%), although only 1 complained of a functional disturbance. We demonstrated favorable long-term results with an extensive venous ligation. While preoperative assessment with color flow Doppler ultrasound, dynamic infusion cavernosography and cavernosometry, and vasoactive substance injection establishes a diagnosis of corporeal veno-occlusive dysfunction, this evaluation provides no predictive indicators for successful outcomes in penile vein ligation.

Investigation of Vascular Changes Following Penile Vein Ligation

In an effort to characterize the changes in penile vasculature that occur following penile vein ligation, we performed pharmaco-cavernosometry and pharmaco-cavernosography on 20 patients after penile vein ligation for comparison with preoperative studies. Three patients with return of erectile function underwent repeat study: 2 were completely normal and 1 had a mild leak from the deep dorsal vein. The remaining 17 patients had continued complaints of erectile impairment. Of these studies 4 showed no evidence of venous leakage, 11 identified a new site of leakage (7 corporo-spongiosal shunts, 2 crural veins and 2 with multiple sites of involvement) and 1 revealed persistent leak through the proximal stump of the resected deep dorsal vein, while 1 patient had an iodine allergy and underwent pharmaco-cavernosometry only. A repeat study in the latter patient showed flow volumes consistent with continued venous leakage.In summary, penile vein ligation appears to be effective at correcting venous leakage noted on cavernosography. However, new sites of leakage frequently appear postoperatively. A corporo- spongiosal shunt was the most frequent site of recurrent venous leakage. A surprisingly high percentage of patients with continued complaints of erectile dysfunction following penile vein ligation demonstrate no venous leakage on subsequent pharmaco-cavernosography.

Penile vein ligation for venogenic impotence.

We have performed penile vein ligation on 35 patients with venogenic impotence from July 1989 to December 1991. The criteria for surgery were (1) age less than 60 years; (2) negative vasoactive agent intracavernous injection but normal penile arterial function, and (3) abnormal venous leakage documented by dynamic infusion cavernosometry and cavernosography. The procedure in venous ligation is excision of the deep dorsal vein from coronary sulcus to pubic arch, and ligation of cavernous veins after identification. The average follow-up was 27.5 months (range 12-37 months) for 30 patients. The 2 patients who revealed no erection at all immediately after operation had dense adhesion of penile hilar region caused in one case by severe pelvic trauma and in the other by pubic bone fracture. Twenty-eight (93.3%) patients were found to sustain excellent erection within 3 months postoperatively. However, only 12 (40.0%) patients sustained spontaneous erection at long-term follow-up, while another 7 (23.3%) responded to intracavernous injection. It is worth mentioning that tortuous and marked dilation of the deep dorsal vein and/or cavernous veins were found intraoperatively in 6 patients who were observed to have excellent erections postoperatively. Inadequate elimination of the leakage veins, especially crural veins, is the most likely factor in those who had a recurrence of erectile dysfunction. However, the corpus cavernosum, particularly a myopathic condition or inadequate neurotransmitters, also plays an important role. Complications included shortness of penis (3 patients), penile deviation (3), numbness of glans penis (4) and wound infection (1).(ABSTRACT TRUNCATED AT 250 WORDS)

Dorsal Vein Sclerosis as a Predictor of Outcome in Penile Venous Ligation Surgery

We studied the pathological specimens obtained from 24 impotent men who underwent proximal penile vein ligation and 6 potent men who underwent total penectomy as part of male-to-female transsexual surgery to determine if a correlation exists between venous pathology and surgical outcome. Pathology specimens, consisting of cavernosal tissue and penile veins, were independently reviewed by a single uropathologist (V. A.). The degree of vein wall thickness was carefully quantified for each patient. Venous leakage was documented by cavernosometry and cavernosography. Followup ranged from 7 to 19 months (mean 11 months).Within 6 months of the procedure 10 patients (41%) achieved rigid erections while 14 (59%) did not. Although no preoperative index could predict operative success, in the 10 patients with successful outcome histological examination of the excised vein segments revealed normal venous architecture with minimal vein wall thickness (calculated mean per cent vein wall thickness 39.4, range 17.5 to 51.7). In contrast, in the 14 patients in whom ligation failed there was marked vein wall thickness and sclerosis (calculated mean per cent vein wall thickness 68.0, range 55.3 to 85.6). In comparison, the vein segments obtained from the 6 potent patients had a wall thickness of 32.8% (range 8 to 39), which was equivalent to the 10 patients with postoperative erections. These findings suggest that there may be a correlation between vein wall thickness and the prognosis of patients who undergo venous ligation surgery for erectile dysfunction secondary to presumed corporeal venous incompetence.

Long-Term Results of Penile Vein Ligation for Impotence from Venous Leakage

Between 1986 and 1991, 46 men with organic impotence documented by dynamic pharmacocavernosometry and cavernosography to have venous leakage underwent penile vein ligation. Despite initial improvement in erections allowing normal intercourse in 34 men (74%) within the first 6 months, long-term (more than 12 months) evaluation revealed sustained potency without adjunctive therapy in only 11 (24%). Of the remaining 35 men 6 (13%) progressed to a penile prosthesis, 8 (17%) required intracavernous vasoactive injection therapy and 21 (46%) have not sought further therapy despite continued impotence. Of the 14 patients who had isolated distal leakage 6 (43%) had sustained erectile function while only 5 of the 32 patients (16%) with proximal leakage maintained potency. Associated complications included penile shortening in 20 (43%) and penile hypoesthesia in 9 men (20%). Therefore, we conclude that the long-term success of penile vein ligation is poor, with only 24% of the patients able to have normal intercourse more than 1 year later, although those patients with distal penile shaft leakage appear to have a greater chance of success than those with more proximal leakage.

Surgical Treatment of Venous Leakage: Medium-Term Follow-Up

Thirty-eight men aged 26-69 years (mean 58) who failed to achieve a full, sustained erection with intracavernosal injections of papaverine and phentolamine (PIPE) and who had evidence of a venous leak on digital subtraction dynamic cavernosography underwent penile vein ligation. Postoperative follow-up ranged from 7 to 44 months (mean 28). Nineteen patients regained spontaneous erections which would allow intercourse (mean follow-up on these men was 23 months). Of these 19 patients, 5 experienced recurrent loss of potency over a 6- to 17-month period (mean 9 months), 4 of these subsequently responding to intracavernosal therapy. Of the 19 without full erections after ligation, 8 obtained erections which would allow intercourse with intracavernosal injections. Two of these patients subsequently lost their response to injections at 2 and 6 months postoperatively. Eleven men had no benefit from surgery (either with or without injections). Of the total of 27 men with erections allowing intercourse, only 19 made an attempted coitus during the follow-up period. Of 9 men with treatment failure who had undergone repeat cavernosography, 8 had evidence of a persistent leak, usually arising from the cavernosal veins. At the time of this study, 4 men had been re-explored, following which 3 obtained erections with the aid of PIPE. Patients who fail to improve following ligation may benefit from re-investigation and repeat ligation using a different surgical approach.

Penile Vein Ligation for Corporeal Incompetence: An Evaluation of Short-Term and Long-Term Results

Dynamic cavernosometry and cavernosography can be used to identify patients with corporeal venous incompetence as a cause of erectile dysfunction. We reviewed our series of 16 patients with venous leakage who underwent surgical correction of the specific abnormality identified on cavernosography. Short-term and long-term results were obtained, and while at least temporary improvement was noted in 89.5% of the patients the long-term results tended to show a reversion to the preoperative status in the majority.

Cavernosography Following Clinical Failure of Penile Vein Ligation for Erectile Dysfunction

In an attempt to determine what occurs to the venous circulation of the penis after ligation of the deep dorsal vein, 9 men with veno-occlusive dysfunction who underwent deep dorsal penile vein ligation and failed to achieve normal erectile function postoperatively consented to a postoperative cavernosogram. Preoperatively, the deep dorsal vein was visualized in all 9 patients, the cavernous vein in 2 and the corpus spongiosum in 1. Postoperatively, the deep dorsal vein was visualized in 1 patient, the cavernous vein in 1 and the corpus spongiosum in 8. These observations suggest that either the inability to identify a cavernous-spongiosal communication preoperatively or the induction of such a communication postoperatively may lead to a clinical failure in patients who undergo deep dorsal penile vein ligation.

This Month in Investigative Urology: Venous Impotence

No AccessJournal of Urology1 Dec 1988This Month in Investigative Urology: Venous Impotence Ronald W. LewisM.D. Ronald W. LewisRonald W. Lewis More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)42125-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Investigative Urology: Venous Impotence." The Journal of Urology, 140(6), p. 1560 © 1988 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byKim E and McVary K (2018) Long-Term Results With Penile Vein Ligation for Venogenic ImpotenceJournal of Urology, VOL. 153, NO. 3, (655-658), Online publication date: 1-Mar-1995.Yu G, Schwab F, Melograna F, DePalma R, Miller H and Rickholt A (2018) Preoperative and Postoperative Dynamic Cavernosography and Cavernosometry: Objective Assessment of Venous Ligation for ImpotenceJournal of Urology, VOL. 147, NO. 3 Part 1, (618-622), Online publication date: 1-Mar-1992. Volume 140Issue 6December 1988Page: 1560 Advertisement Copyright & Permissions© 1988 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Ronald W. Lewis More articles by this author Expand All Advertisement PDF downloadLoading ...