- Letter to the Editor
- Open Access
- Published:
To the editor-an update on endovascular treatment of venogenic erectile dysfunction
CVIR Endovascular volume 5, Article number: 30 (2022)
To the editor
We refer to our case report „Venogenic erectile dysfunction: diagnosis on computed tomography cavernosography and endovascular treatment using an anterograde access via deep dorsal penile vein “as recently published in CVIR Endovascular (Hoppe and Diehm 2022).
Supplementary procedural aspects
With the intention to make this endovascular treatment more easily accessible to endovascular interventionalists, we compiled additional visual material straight from the angiosuite including a movie file to step-by-step demonstrate endovascular treatment of venogenic erectile dysfunction using an anterograde access via a deep dorsal penile vein (Figs. 1, 2, 3 and 4)
Novel procedural aspects
As previously mentioned, we use a micropuncture set with a 21-G needle, an 0.018-inch guide wire and a stiffened cannula for ultrasound guided deep dorsal penile vein access. Use of a stiffened cannula appears to be more advantageous compared to a floppy cannula due to roughness of the penile fascia (Buck’s fascia). Recently we figured out that a stiff 3-F inner dilator is easier to introduce through the penile fascia into the deep dorsal vein without the 4-F outer catheter. Of interest, there is no relevant impairment of liquid embolic agents’ flow characteristics. This finding is confirmed by previous study results of Palacios et al. demonstrating that 3-F inner dilators are capable of achieving flow rates of at least 6 mL/sec (Palacios et al. 2009).
Future perspective
However, despite of the promising result of this case report, more scientific evidence is needed regarding endovascular treatment of erectile dysfunction, especially in patients with venous leak. In the meantime, we have treated more than 50 patients for venogenic erectile dysfunction using an endovascular approach with antero-grade access via a deep dorsal penile vein and are currently working on a data analysis and publication of our results in the near future for further clarification.
After subcutaneous administration of lidocaine 2% for local anesthesia and light sedation, ultrasound-guided puncture of a deep dorsal penile vein is performed using a 21-G micropuncture needle (Cook, U.S.A.). The needle is slowly advanced until blood returns from the needle hub (ref. corresponding movie file)
A A 3-F stiffened cannula out of a 4-F micropuncture set (Cook, U.S.A.) is inserted over the guide wire after the needle has been removed with its tip positioned intravenously in close proximity to the radix penis. Usually, a stiff dilator is more advantageous compared to a floppy one due to roughness of the penile fascia (Buck’s fascia). The introducer hub is connected to a 3-way stopcock with a short connecting tube (Discofix, Braun, Germany). B Venogram demonstrates venous leak (arrows) via periprostatic and internal pudendal veins. C Tubing is flushed with 5% glucose solution (light blue 3 cc syringe) and subsequently venous embolization is performed (violet 3 cc syringe) using a mix of N-butyl-2-cyanoacrylate glue (Glubran II, GEM, Italy) and ethiodized oil (Lipiodol, Guerbet, Switzerland), as exemplarily demonstrated. D Distribution of embolization material via periprostatic and internal pudendal veins (arrows)
Availability of data and materials
All data generated or analysed during this study are included in this published article.
Abbreviations
- G:
-
Gauge
- F:
-
French
References
Hoppe H, Diehm N (2022) Venogenic erectile dysfunction: diagnosis on computed tomography cavernosography and endovascular treatment using an anterograde access via deep dorsal penile vein. CVIR Endovasc 5(1):10
Palacios RG 3rd, Hardman RL, Lopera J (2009) In vitro study assessing the technical feasibility of using 3-F inner dilators for imaging. J Vasc Interv Radiol 20(7):959–963
Acknowledgements
Not applicable.
Funding
Not applicable.
Author information
Authors and Affiliations
Contributions
HH: Concept of manuscript, outline of topics, scientific writing, and performance of endovascular treatment of venogenic erectile dysfunction. ND: Outline of topics, manuscript drafting, and performance of endovascular treatment of venogenic erectile dysfunction. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Ethics approval and patient consent to participate are available (EKNZ 2018–00408).
Consent for publication
The patient has given written informed consent for the publication of the medical history and all the accompanying images. The patient is aware of the nature of open access publishing.
Competing interests
Not applicable.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Additional file 1.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Hoppe, H., Diehm, N. To the editor-an update on endovascular treatment of venogenic erectile dysfunction. CVIR Endovasc 5, 30 (2022). https://doi.org/10.1186/s42155-022-00310-5
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s42155-022-00310-5