Three‐dimensional CT cavernosography: reconsidering venous ligation surgery on the basis of the modern technology

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Abstract
Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Venous ligation surgery has been conducted as a symptomatic treatment, but the effective rate of this surgery was insufficient. We thought that one of the reasons for the low effective rate of this surgery was insufficient for the diagnostic modality. We confirmed that 3D cavernosography was, in comparison with conventional cavernosography, higher in diagnosis precision. OBJECTIVE: To examine the feasibility of three‐dimensional (3D) CT cavernosography in the diagnosis of corporal veno‐occlusive dysfunction. PATIENTS AND METHODS: The subjects were 55 patients who had failed to respond to phosphodiesterase type 5 inhibitors. We performed pharmacodynamic infusion cavernosometry and cavernosography, using 60 mg papaverine hydrochloride. Cavernosography was performed at 90 mmHg intracavernous pressure, using a multi‐slice CT scan system. The 3D images were reconstructed using aquarius net station , ver.2 computer software. For comparison with conventional cavernosography, maximum intensity projection (MIP) images were used. A flow of 20 mL/min or being more capable of maintaining 90 mmHg of intracavernous pressure indicated veno‐occlusive dysfunction. RESULTS: Forty‐five of the 55 patients were diagnosed with corporal veno‐occlusive dysfunction. 3D‐CT cavernosography revealed drainage veins in all 45 cases, including cavernous veins, dorsal veins, crural veins and other emissary veins. Compared with 3D‐CT cavernosography, observing cavernous veins and the proximal part of the deep dorsal veins using MIP imaging was especially difficult because the origins of the penile veins are often behind the pelvic bone or cavernous body. Of the patients who seemingly had leakage via the deep dorsal vein, 80.6% did not in fact have leakage via this vein, but had other leakages. The image resolution of 3D‐CT cavernosography was significantly higher than that of MIP. CONCLUSION: 3D‐CT cavernosography can provide high‐resolution images of venous drainage from any angle. We conclude that the images obtained by 3D‐CT cavernosography are very helpful for both the diagnosis of corporal veno‐occlusive dysfunction and the anatomical study of the human penile venous system.

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