Erectile dysfunction (ED) is a big issue in various populations worldwide. Erectile dysfunction is defined as a situation or inability to achieve and/or maintain penile erection that is sufficient for satisfactory sexual performance. It’s been observed that around 52% of the male population is affected with ED amongst which over 30% of young males are suffering from this condition. Scientific investigations have observed that the prevalence of ED is strongly associated with increasing age, making it a major health problem since with the increase of the aging population, the worldwide prevalence of ED has been predicted to reach 322 million by 2025.
Blood vessels play a prime role to keep erections firm. Under normal physiological circumstances, during sexual arousal nerves release chemicals that increase blood flow into the corpus cavernosum (erection chambers in the penis), the arteries in the penis expand to allow the inflow of blood which makes the erection firm. However, to keep the erection rigid, blood needs to stay in the penis until the man ejaculates. For this, penile veins constrict to trap the blood inside, which is known as veno-occlusion. At the end of sexual stimulation, the veins widen and blood flows back into the body. If the veins do not constrict enough, blood leaks back into the body, which results in softening of the erection, this phenomenon is known as a venous leak in which the erection gradually loses its firmness. Therefore, venous leak is a defect where a male is unable to have strong erections even with sufficient blood into the penis as a result of abnormal venous drainage in the penis corpora cavernosa, thus retarding the typical erectile capability of men. Venous leak is often listed under erectile dysfunction causes in younger men. Surveys have found that about 70% of the affected population by ED does not get treated therefore, men suffering from this condition experience shame and choose to be secluded in sexual relations. If you have concerns regarding being affected by this condition, contact your urologist, and get an early treatment since venous leakage is treatable. Although there are quite a few causes of erectile dysfunction, nonetheless, many non-invasive remedial options are available for such patients that will improve fertility and its progression.
Erectile Dysfunction Causes
There are many different underlying factors that can qualify as erectile dysfunction causes. Based on etiology, erectile dysfunction is divided into three major types: psychological (such as depression, stress, and anxiety), organic (related to vascular system, nervous system and endocrine system) and mixed.
When we talk about organic causes, defects in the physiology of vascular system are a common occurrence, in patients with venogenic erectile dysfunction, veno-occlusive dysfunction is recognized as underlying cause in most cases which can be due to either aging or injury related changes to the tunica albuginea, cavernosal smooth muscle dysfunction or excessive adrenergic input or shunts created during priapism episodes. There are several potential risk factors such as age, diabetes, obesity, cardiovascular disorders, hypertension, atherosclerosis, prostatectomy, pelvic radiation, Peyronie’s disease (development of scar tissue inside the penis), and androgen deprivation therapy that appear to be associated with organic ED.
Diagnosis and Treatment
In order to diagnose venous leak erectile dysfunction, your doctor will take your personal history, would likely do a physical examination, and recommend some tests such as Penile doppler ultrasound,certain male hormone and routine blood tests along with urine tests to rule out any doubts.
It is advisable for patients with venous leak erectile dysfunction to make lifestyle modifications and prevent physiological stresses to overrule these conditions and take adjunct medications. Furthermore, for patients suspected with ED are commonly prescribed phosphodiesterase type 5 inhibitors (PDE5Is) therapy which is not a curative treatment but rather symptom-relieving treatment and loses its effect in in a few months. There are surgical interventions also available in the market such as penile implant(recommended only in elderly and patients who had radical prostate surgery) and venous ligation surgery, which aims to repair the leaking veins(discouraged by surgical fraternity for recurrence and high failure rates).
Moreover, an interventional radiological approach that is endovascular treatment is a promising approach to treat patients with erectile dysfunction or venous leakage. Endovascular therapy with 3D precision-guided embolization of venous leak is a minimally invasive procedure and a safer alternative to surgical methods. For endovascular embolization, administration of local anesthesia followed by real-time fluoroscopic monitored puncture of a venous access is performed to reach the leaking veins and periprostatic venous plexus under sonographic and 3-D precision guided fluoroscopic guidance.
The non-invasive endovascular treatment can be performed by two different approaches, such as antegrade approach via deep dorsal penile vein and retrograde transfemoral venous approach via internal iliac veins. Although both approaches aim to embolize the periprostatic venous plexus along with other unusually shaped or abnormally functioning veins due to valvular incompetence, antegrade endovascular treatment is preferred since it provides a more direct route for catheterization of the periprostatic venous leaks.3D Precision guided fluoroscopic guidance helps the catheter reach the specific veins, following a diagnostic venogram embolization is performed using N-butyl-2-cyanoacrylate and ethiodized oil mixed in specific ratios depending on proximity, size and extent of venous leaks under continuous fluoroscopic control in neutral projection with optional oblique projection for precison guided embolization of incompetent pelvic veins.
This non-surgical treatment- 3D precision-guided embolization of venous leak is a complex and challenging procedure which requires high expertise in the said field. Its treatment in Pakistan was introduced by Dr. Imtiaz Ahmed in 2019, making him a pioneer. Dr Imtiaz Ahmad is an endovascular surgical specialist and an interventional radiologist who treats men suffering from venous leakage, erectile dysfunction and infertility issues that may have little hope left otherwise. His expertise in the field speaks volume for itself, which can be inferred by the accolades of his treated patients.
Venous leak treatment may bring back the missing happiness in your married life. Learn more about venous leak treatment without surgery in Pakistan.
Why is it important to know about venous leak?
The information around male infertility and issues of the male reproductive system is limited in comparison to female reproductive problems. Research done to study infertility has greatly revolved around women because the birthing process involves a woman. Furthermore, a great lack of awareness in men and their inability to communicate even if they do find out about their problem further causes a lag in curing this issue. However, it is essential that this knowledge is imparted to the masses, as 1 in 3 cases of failure in pregnancy has been attributed to male factor infertility. Male infertility is simpler to understand as opposed to women, where the fertilization occurs, and the body has to sustain the pregnancy.
Factors leading to male infertility can broadly be divided into two main categories: Productive and Obstructive. The two comprise error or absence in sperm production and failure in the delivery of the sperm. The reasons for both or either of these to exist may be concerned with a congenital disorder, physical injury, hormonal abnormality, varicocele leading to high temperature, retrograde ejaculation, or a venous leak. Venous leak is one of the culprits behind male infertility, but venous leak treatment and alternate options do exist to find a proper cure.
What is a Venous leak?
Under normal physiology during tumescence (state of erection), the blood inflow to the penis is faster than the outflow due to arterial dilation and venous occlusion, helping sustain the state of erection. One of the causes of not being able to do so is a venous leak, wherein the blood that must be stored in the sinusoids from a few minutes up to half an hour leaves too quickly, much like a bottle of water with a hole in it. The vein leakage may occur anywhere in the body, especially in the legs and the area around the stomach. Venous leak has been associated with being the most common cause of erectile dysfunction (ED) in men but cannot always be concluded as the sole reason for impotency, owing to a multitude of factors involved. Statistically, one in five men suffer from ED and seek venous leak treatment after they notice symptoms of venous leak. Such men may complain about an abnormality in tumescence but experience a normal libido/sexual drive, otherwise.
The diagnosis for venous leak is multistep, to confirm the network of veins involved in the damage. To put it simply, the velocity of blood inflow and outflow to the penis is recorded and compared to the standard values. Additionally, certain blood tests are also performed to have a clear idea about the hormone levels and other comorbidities. Once venous leak is suspected over the doppler ultrasound, cavernosometry and cavernosography may be performed to locate specific sites of venous leak.
Venous Leak Treatment: Know Your Options
The most common surgical vein leakage treatment is the ligation surgery. Venous leak can be treated by surgery via ligation of the deep dorsal veins, but it has been repeatedly reported that very high failure rates and the efficacy of the treatment is greatly reduced after an approximate 12-month period. Collateral arteries that develop from the arteries responsible for primary venous leak have been associated with the reduction in the efficacy of this treatment. Another option that the patients may be able to seek is of penile implant. Penile implants are also known as penile prosthesis and come in a few different types. The focus is on providing an artificial way of maintaining tumescence. The implant is suggested to patients who have already tried other methods and haven’t seen any success. Penile implants can improve the sexual performance, leading to improvement in mental health issues rooting from this issue. The surgery for penile implants observes a slow recovery with severe pain for the first week followed by a chronic pain for two to three months. At present, Endovascular therapy done as 3-D precision guided embolization is found to be the safest and minimally invasive venous leak treatment. The treatment is performed under fluoroscopic guidance and falls under the umbrella of interventional radiology treatment methods.
Venous Leak Treatment Without Surgery
Venous Leak treatment in Pakistan is being conducted by Dr Imtiaz Ahmad, who is an endovascular surgical specialist, and an Interventional Radiologist.He is the pioneer of this treatment and started offering it for the first time in Pakistan since january 2019.This venous leak cure is a non-surgical and minimally invasive procedure to treat venous leak erectile dysfunction. Men who are young and respond, certainly not very well, but to some extent, to PDE5 inhibitors are strongly advised to undergo venous leak treatment without surgery. The no