Venookklusive erektile Dysfunktion: aktuelle Übersicht und klinischer Leitfaden

Zusammenfassung

Hintergrund

Erektile Dysfunktion (ED) ist einer der häufigsten Vorstellungsgründe in der urologischen Praxis. Trotz des wesentlichen Fortschritts im Verständnis der Pathophysiologie der ED bleiben noch einige vaskuläre Ursachen, wo diagnostische und therapeutische Maßnahmen nicht einheitlich sind.

Fragestellung

Was ist der richtige Weg bei Verdacht auf eine venöse Leckage? Was ist der Stellenwert der venösen ligierenden Operationen und der radiologischen Interventionen?

Material und Methoden

Die narrative Literaturübersicht der vorhandenen Quellen hinsichtlich der venösen kavernösen Insuffizienz.

Ergebnisse

Die Ursachen der kavernösen venösen Insuffizienz sind heterogen. Die effektivste Behandlunsgmethode ist Implantation einer Schwellkörperprothese. Die venösen ligierenden Operationen oder radiologischen Interventionen sind keine verlässliche Therapieoption aufgrund des Rezidivrisikos.

Schlussfolgerungen

Die Patienten mit einer kavernösen venösen Insuffizienz sind Kandidaten für die Implantation einer Schwellkörperprothese. Die Gefäßinterventionen bei dieser Patientengruppe können im Rahmen von klinischen Studien durchgeführt werden.

Abstract

Background

Erectile dysfunction (ED) is one of the most frequently reasons for patient presentation in the urological practice. Despite fundamental progress in the understanding of ED pathophysiology, there are some vascular forms of ED where the diagnostic and therapeutic pathway is not clear (cavernous venous insufficiency).

Objectives

What is the right procedure when venous leakage is suspected? How important are venous ligation surgery and radiological interventions?

Materials and methods

Narrative literature review of the available sources on cavernous venous insufficiency.

Results

The reasons for venous cavernous insufficiency are heterogenous. The most effective and reliable therapy option is penile prothesis implantation. Venous ligation surgery or radiological interventions are not reliable options, because of the risk of recurrence.

Conclusions

Patients with venous cavernous insufficiency are candidates for penile prosthesis implantation. In this group of patients, vascular interventions may be performed as options for clinical study.

Fazit für die Praxis

• Die Möglichkeit einer venookklusiven Insuffizienz sollte immer im Rahmen der Diagnostik und Therapie bei ED beachtet werden.

• Die Patienten mit einer VOED sollten über alle diagnostischen und therapeutischen Optionen aufgeklärt werden.

• Die aktuelle Datenlage und Effizienz der therapeutischen Optionen sollte den Patienten so früh wie möglich erläutert werden, um die unrealistischen Erwartungen zu vermeiden.

• Bei Bedarf sollte gleichzeitig mit der Diagnostik und Therapie eine sexualmedizinische psychologische Anbindung angeboten werden (CAVE: keine Kostenübernahme durch GKV).

• Venookklusive therapeutische Interventionen werden nicht empfohlen.

Schlüsselwörter

erektile Dysfunktion - venookklusive erektile Dysfunktion - kavernöse venöse Insuffizienz - penile venöse Operationen - penile Gefäßinterventionen

Keywords

erectile dysfunction - venoocclusive erectile dysfunction - cavernous venous insufficiency - penile venous surgery - penile vascular surgery

Publication History

Received: 13 September 2024

Accepted after revision: 04 January 2025

Article published online:
04 February 2025

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