Treatment Of Penile Venous Leakage

What is venous leakage?

Penile venous leakage, or venous insufficiency, refers to the condition where blood flows back through the veins during an erection, preventing the accumulation of sufficient blood in the penis and leading to an inability to achieve or maintain a firm erection.

How does an erection occur?

During an erection, the cylindrical structures in the penis known as the corpus cavernosum fill with arterial blood at a high flow rate, regulated by hormonal and neural modulators. Meanwhile, the venous (vein) drainage is restricted due to compression between smooth muscle structures, leading to increased internal penile blood pressure and the achievement of an erection.

How does venous leakage happen?

In the rigid erection phase, blood should be trapped inside the penis. However, due to congenital factors or acquired damage from trauma, structural deterioration in smooth muscles and vascular structures can lead to venous blood leakage.

Can venous leakage occur at a young age?

Congenital veno-occlusive dysfunction, commonly known as congenital venous leakage, typically presents symptoms at a young age. Individuals with this condition often report that they have never been able to achieve sufficient erection for vaginal penetration, or even if they do with treatment, they lose penile rigidity before reaching orgasm.

How to check if you have a venous leak?

After taking a detailed medical history, patients suspected of having penile venous leakage undergo penile doppler ultrasonography. This imaging technique is highly effective in making an accurate diagnosis, as it can detect both arterial and venous insufficiency.

Does viagra fix venous leak?

Patients diagnosed with venous leakage are usually those who have not benefited from medications (sildenafil, tadalafil),P-SHOT, or ESWT therapy.

How do you fix a venous leak?

These treatment methods generally have low success rates. Scientifically recognized treatment options for these patients include ablation, embolization, and venous leakage surgery (venous ligation). While these treatments provide short-term success, their recurrence rates in the medium and long term are high, leading many patients to consider penile prosthesis surgery.

Venous leakage ablation

There are limited scientific studies on this method. The goal is to block the problematic veins using various sclerosing agents. However, it is not a commonly practiced treatment today.

Penile venous leakage embolization

This is an angiographic procedure in which microcatheters are used to access the veins and embolizing agents are applied to block the periprostatic and dorsal veins. The goal is to prevent venous leakage, thereby allowing sufficient rigidity in the penis during an erection. Scientific studies show an initial success rate of 80-90% in the first three months, but this rate drops to around 50% after one year.

Venous leakage surgery (Venous ligation)

This surgical method involves tying off the deep dorsal vein and cavernosal veins of the penis through a small incision. Like embolization, it shows promising short-term results but has a high recurrence rate (30-40%) within the first year. Various techniques have been tried to reduce this recurrence. Side effects include penile shortening in 10-40% of cases, penile curvature in 10%, and, less commonly, loss of sensation and wound infections.

How long does venous leakage surgery take?

The venous ligation procedure for penile venous leakage takes approximately one hour. It can be performed under general or spinal anesthesia.

Can low testosterone cause venous leak?

No. Although low testosterone levels can cause some venous insufficiency, low testosterone is not found to be responsible for venous leaks that seriously impair erection.

Penile implant surgery for venous leakage

For young patients with unexplained venous leakage or penile venous insufficiency due to trauma, the most effective and successful treatment is the implantation of a penile prosthesis. If simpler treatment methods fail, penile prosthesis surgery becomes inevitable. However, its disadvantages include high cost and irreversibility, which should be explained to the patient. Unless there are special conditions, three-piece inflatable penile implants are generally preferred, as with other penile prosthesis cases.

What is the best treatment for venous leakage?

The most effective treatment for venous leakage that does not respond to initial steps is penile implant surgery.

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