Penile venous insufficiency or corporal veno-occlusive dysfunction, commonly known as venous leak is often a consequence of a vascular disease since the vascular network is well connected throughout the body. Vascular diseases comprise faults in vessels, veins or arteries but may also influence the blood flow to different tissues. To understand venous leak, the mechanism of tumescence, or erection must first be understood. Under normal physiology during tumescence, 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 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. This happens due to inefficient sinusoidal relaxation and expansion which results in a poor attempt to close the emissary veins that drain the sinusoids. The process of constricting blood outflow under normal physiology is known as veno occlusion but the failure of it may be due to venous leak. Venous leak has been attributed to being the most common cause of venogenic impotence or erectile dysfunction (ED) in men but cannot always be concluded as the sole reason for impotence, owing to a multiplex of factors involved. Statistically, one in five men suffer from ED and seek venous leak easy treatment after they notice venous leak symptoms. Such men may complain about abnormality in tumescence but experience a normal libido, otherwise.
What Causes Venous leak?
Venous leak may occur in men eventually over the course of life but can also be congenital, meaning, faults in the venous drainage system around the penis may be persisting since birth. The pathophysiology of a venous leak is rather ambiguous, to date, however, studies have found venous leak to be of a more common incidence in elderly men, men with diabetes mellitus, or those who have undergone prostatectomy, hormone therapy and radiation therapy. Causes of a venous leak may also include accidents and physical injury. Interestingly, many men seeking treatment for erectile dysfunction end up finding diseases they are at a risk of developing and would have, otherwise, found out once the symptoms had worsened. It is, therefore, crucial for the overall well-being of a man to reach out to a specialist rather than shying away from the symptoms of venous leak erectile dysfunction.
Venous Leak Symptoms and Diagnosis
The most obvious symptom of a venous leak is facing difficulty in maintaining tumescence. This may include a short span of erection, not being able to get one at all, difficulty sustaining it unless manual stimulation is provided, penis shrinkage (Peyronie’s disease), or cold glans syndrome wherein the vascular structure forming at the tip of the penis called glans, does not fully swell during tumescence.
Psychogenic factors leading to erectile dysfunction are first ruled out and history taking is streamlined to include only organic causes. If the specialist suspects a venous leak in the patient, a penile doppler ultrasound is performed. The procedure first requires the administration of a Vasodilator that causes an erection as the blood flows and fills the sinusoids in the penis. An ultrasound probe is then kept in a longitudinal arrangement (from tip to the belly) and is used to record the velocities of inward and outward blood flow at regular intervals. Ideally, the inward blood flow velocity(systolic) should be 25 to 35 cm/s and outward flow velocity(diastolic) of less than 3-5 cm/s is regarded as normal. In case of lesser values of systolic velocity, an arterial disease may be diagnosed while diastolic diseases like venous leak can be concluded if velocity is greater than 5cm/s. Venous leak cure foundations on finding the location of the leak and is a complex process. 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 Options
Treatment approach largely depends on a lot of factors such as age and comorbidities. The first choice of treatment is the administration of PDE-5 inhibitors like Cialis, Viagra and Stendra, to help alleviate the symptoms, however, they have a lower success rate, regardless. Additionally, sclerosing agents may also be administered to achieve tumescence. Being the most common approach towards venous leak treatment, surgical treatment options available are not only invasive but also criticized for having a very low success rate (approximately 25%). The ligation of veins results in a painful state of erection post-surgery along with high recurrence and is therefore, frowned upon as an approach towards venous leak treatment.
Non-Surgical Treatment for Venous Leak
Venous Leak treatment in Pakistan is being conducted by Dr Imtiaz Ahmed and is a non-surgical, 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 non-surgical treatment. The non-surgical endovascular treatment takes on two main approaches: antegrade and retrograde. Both approaches aim to embolize the peri-prostatic venous plexus along with other veins that may seem irregular in shape or function. Antegrade endovascular treatment is performed via the deep dorsal penile vein while retrograde treatment involves transfemoral path via the internal iliac vein. Fluoroscopic guidance helps the catheter reach the selective veins after which glue therapy is performed using specialized FDA approved drugs. Out of the two approaches, specialists prefer using the antegrade approach, which provides a much straighter route to the periprostatic veins. The non-surgical treatment for venous leak is a complex and challenging procedure which requires expertise in the field.
