When the venous system of the penile corpus cavernosum malfunctions, causing the pressure in the corpus cavernosum to not reach 80 millimeters of mercury, or when the venous return system of the corpus cavernosum cannot effectively close, resulting in ineffective reduction of venous return during erection, a large amount of blood leaks from the veins, thus preventing the penis from achieving a normal or sufficient erection.
Symptoms of venous leakage
Young people should not feel psychological pressure, and should not be deceived by unscrupulous private clinics. Some news reports claim that the majority of erectile dysfunction cases are caused by venous leakage.
There is no data to support this claim. Some young people in their twenties go to the hospital and are diagnosed with venous leakage. The doctor strongly recommends surgery. Unable to resist the persuasion, they undergo surgery, which leaves them impotent for the rest of their lives. And that's the end of the story.
Examinations for venous leakage
1. Corporal pressure measurement
2. Corporal angiography
3. Color duplex ultrasound
Treatment methods
The main approach is to block the venous blood flow in the penile corpus cavernosum by ligation, in order to achieve effective penile erection.
1. Surgical indications: congenital penile venous dilation or excessive number of veins, abnormal communication between the penile corpus cavernosum and urethral corpus cavernosum, commonly seen in congenital deformity or patients who have undergone diversion surgery due to prolonged penile erections.
Patients should consider undergoing surgery after Doppler ultrasound examination shows good arterial response; intracavernous injection therapy and vacuum negative pressure device have poor efficacy.
Smokers; those without severe systemic diseases such as diabetes and arteriosclerosis; age younger than 60 years old.
Before surgery, repeat the measurement of penile corpus cavernosum pressure or perform penile corpus cavernosum angiography, which is helpful for determining the route of venous leakage and the appropriate surgical approach.
2. Surgical methods: a. Deep dorsal vein ligation; b. Penile corpus cavernosum foot vein ligation; c. Penile corpus cavernosum vein ligation; d. Urethral corpus cavernosum stripping; e. Bilateral internal iliac vein ligation.
The deep dorsal vein ligation surgery is a procedure that treats venous leak erectile dysfunction by ligating the deep dorsal vein of the penis.
It can be performed under local anesthesia or spinal anesthesia. A long incision of 3cm is made on the dorsal side of the penis, starting from the root and extending downwards. The deep dorsal vein of the penis is located in the groove formed by the corpus cavernosum on the upper and lower sides, and the dorsal artery of the penis can be seen on both sides.
After finding the deep dorsal vein of the penis, it can be freed from the root of the penis to a distance of 5cm, and its branches can be ligated. Then, the main trunk can be ligated at both ends, and a 5cm segment of the deep dorsal vein can be excised.
After the ligation and division of the vein, papaverine and phenylephrine can be injected to induce artificial erection.
First, a tourniquet is applied at the base of the penis, and then 60mg of papaverine and 2mg of phenylephrine are injected into one side of the penile corpus cavernosum. Two minutes later, the tourniquet is released, and partial patients may experience an erection after about 10 minutes.
At this point, 100ml of normal saline can be injected into the corpus cavernosum at a rate of 60ml/min, and the penis will achieve a good erection, indicating the success of the ligation surgery.
