New Classification of Anomalous Venous Drainage Using Caverno-Computed Tomography in Men with Erectile Dysfunction

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Abstract
Introduction: Venous leak evaluation remains a challenge in many ED patients. Adequate anatomical evaluation may help with optimizing therapeutic strategies.Aim: Propose a new classification of venous leakage using multidetector computed tomography (MDCT) cavernography, after contrast media intracavernous injection (ICI), under pharmacological stimulation.Methods: Thirty-eight patients gave informed consent for the study: 34 complained of ED, unsatisfied with treatment and suspected to have cavernovenous leak; four having morphological anomalies and needing surgery. Patient's clinical history, including age, vascular risk factors, penile nitric oxide release test, Doppler ultrasound and previous treatments were evaluated. MDCT consisted in: 1-ICI of 1 mL of vasoactive medications containing papaverine, chlorydrate (20 mg), urapidil chlorydrate (2.75 mg) and alprostadil (10 mcg); 2-ICI of 20–60 cc of diluted contrast media (1/3) using 20 cc of Ioprimide (300 mg/mL); 3-Spiral MDCT acquisition and three-dimensional volume rendering.Main Outcomes Measures: Erection degree was assessed using the erection hardness score (EHS); venous drainage was analyzed and deep, superficial veins (SVs), and caverno-spongious communications identified. MDCT findings were compared with clinical data.Results: The deep dorsal vein (DDV) was opacified in 58% of patients and the SV in 50%. Cavernospongious communications were visible in 18.4%. Sixteen percent presented no visible drainage. A new classification of venous drainage anomalies is proposed: A—No visible drainage (N = 8); B—DDV and preprostatic plexus opacification (N = 11); C—Exclusive SV opacification (N = 10); D—Opacification of both SV and DDV (N = 9). All patients (with one exception) in group A quoted 4 at the EHS vs. none in the others groups (P < 0.0001, exact Fisher test). One patient in group A needed venous drainage due to prolonged erection.Conclusions: MDCT after ICI contrast media was able to differentiate between various venous pathways in men with venous origin ED, leading to a new anatomical classification. Absence of leakage was associated with normal erection under pharmacological stimulation.

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