Selective penile venography: anatomical and hemodynamic observations.

Penile venographic studies were reviewed to determine the basic radiographic anatomy and hemodynamics. A total of 14 patients underwent 17 selective deep venographic studies in association with planned transcatheter venous ablation. In addition, radiography of the glans was performed in 9 patients and superficial dorsal venography was done in 5. These studies provided a much clearer demonstration of penile venous anatomy than did cavernosography. Important new observations were that the crural perforators were discretely visualized and observed to empty into the medial portion of the internal pudendal veins; flow in the internal pudendal veins was observed to be potentially bidirectional; the confluens of veins at the base of the pre-prostatic plexus served as a conduit through which catheters and sclerosants could be directed to all major portions of the deep penile venous system; in impotent patients at least contrast medium usually refluxed from the deep veins into the erectile bodies during a Valsalva maneuver; direct communications between deep and superficial venous systems were few or nonexistent in the penis, and the glans drained primarily via the deep dorsal penile vein.