Advances in Venous Leak Embolization: A paradigm Shift in Treating Erectile Dysfunction

Purpose: Erectile dysfunction significantly impacts men globally, affecting their quality of life. Multiple etiologies, including psychological, organic, and vasculogenic factors (both arterial and venous impairments), contribute to this condition. Of particular interest is the role of venous leak disease in hindering proper erectile function.

Materials and Methods: We conducted a study involving 45 patients diagnosed with venous leakage disease via Doppler ultrasound between November 2022 and November 2023. Initial assessments ruled out other underlying causes of erectile dysfunction. Subsequent Doppler ultrasound, following papaverine injection, and cavernosography under fluoroscopy guidance confirmed the diagnosis. Ultrasound-guided embolization using a mixture of glue n-butyl 2 cyanoacrylate (NBCA) and Ethiodized oil in a 1:1. 1:2 ratios was performed. We evaluated the International Index of Erectile Function-15 (IIEF-15) scores before and 4 weeks after the procedure, defining a treatment response as a score increase of four. Primary safety outcomes included adverse effects like priapism, pain, and pulmonary emboli within the first 4 weeks.

Results: Out of 45 patients, 40 with moderate to severe erectile dysfunction underwent antegrade venous embolization (88.8%). Retrograde access was utilized in five cases (11.2%) due to technical failures. The 4-week follow-up showed primary efficacy in 35 patients (77.7%). The IIEF-15 score increased from 10.5 ± 5.3 to 15.6 ± 8.4 among 29 patients postprocedure. Short-term follow-up confirmed clinical success in 32 of 35 patients (91.4%), with continued erectile function in 28 patients at the end of follow-up. However, four patients experienced a progressive decrease in procedural benefits over time. Notably, no major adverse effects were observed except for transient pain within the first 24 hours.

Conclusion: Venous leak embolization therapy is in a transformative phase due to advancements in endovascular techniques and new embolic materials. The study underscores promising outcomes in treating erectile dysfunction, paving the way for further exploration in this field.

Publikationsverlauf

Artikel online veröffentlicht:
02. April 2024