Malossini G, Ficarra V, Cavalleri S, Morana G, Zanon G, Mansueto G C
Cattedra Clinicizzata di Urologia, Università degli Studi di Verona.
Arch Ital Urol Androl. 1998 Sep;70(4):203-9.
The treatment of impotence due to venous leakage is remedied by creating an increase in the resistance of the venous outflow in order to trap arterial blood within the corpora cavernosa of the penis during erection. The percentage of success reported in Literature after resection of the deep dorsal vein and ligature of the cavernous veins varies from a minimum of 12.5% to a maximum of 75%. Interventional radiology represents a valid alternative to traditional surgery in the non-prosthesis treatment of erectile dysfunction of venous origin due to the absence of complications and lack of intrusiveness and for the encouraging short and mid term results obtained. From May 1991 to February 1997, seventeen patients (aged between 24-54, average age 36 years) affected by venous leakage underwent embolisation of the principal veins of drainage of the corpora cavernosa. All patients were previously strictly selected in order to exclude those affected by arterial, neurological, endocrine or ++psychological disease. Pathologic venous drainage was shown by pharmacocavernosometry and pharmacocavernosography. The technique employed consisted in isolation and catheterization of the deep dorsal vein of the penis with a cannula needle of 14 G and subsequent ligature and simple section of the vein; venous leakage fluoroscopic evaluation; coils placement under radiological control, in the distal tract of each vein chosen to be occluded; and then at last, embolization of the deep dorsal vein. A fluoroscopic control performed after these procedures showed the correct vascular occlusion. The operation has an average duration of 120 minutes and requires two-day hospitalisation. In 12% (2/17) of the selected cases a technical failure was recorded due to difficult catheterization of the periprostatic plexus, therefore only surgical ligature and section was carried out in the penile deep dorsal vein. Only in one case (6%) there was a slight and transitory oedema of the penis observed. The average follow-up is 34 months (range 3-72 months). Up to now, 11 patients over 15 (73.4%) refer a good improvement of erectile dysfunction together with a satisfactory sexual activity. In two cases (13.3%) only partial improvement have been referred. Only 2 cases (13.3%) did not obtain any benefit from treatment.
静脉漏所致阳痿的治疗方法是通过增加静脉流出阻力，以便在勃起时将动脉血滞留在阴茎海绵体内。文献报道，在切除阴茎背深静脉和结扎海绵体静脉后，成功率最低为12.5%，最高为75%。介入放射学是静脉性勃起功能障碍非假体治疗中传统手术的有效替代方法，因为它没有并发症，侵入性小，且短期和中期结果令人鼓舞。1991年5月至1997年2月，17例（年龄在24 - 54岁之间，平均年龄36岁）静脉漏患者接受了海绵体主要引流静脉的栓塞治疗。所有患者此前均经过严格筛选，以排除患有动脉、神经、内分泌或心理疾病的患者。通过阴茎海绵体药物注射测压法和阴茎海绵体药物血管造影术显示病理性静脉引流。所采用的技术包括用一根14G的套管针分离并插入阴茎背深静脉，随后结扎并简单切断该静脉；通过荧光镜评估静脉漏；在放射控制下，将线圈放置在每条选定要闭塞的静脉的远端；最后，栓塞阴茎背深静脉。这些操作后进行的荧光镜检查显示血管闭塞正确。该手术平均持续时间为120分钟，需要住院两天。在所选病例中，12%（2/17）因前列腺周围丛插管困难记录为技术失败，因此仅对阴茎背深静脉进行了手术结扎和切断。仅1例（6%）观察到阴茎有轻微的暂时性水肿。平均随访时间为34个月（范围为3 - 72个月）。到目前为止，15例中有11例（73.4%）称勃起功能障碍有明显改善，性活动满意。2例（13.3%）仅部分改善。仅2例（13.3%）未从治疗中获益。
