INVESTIGATION OF VASCULAR CHANGES FOLLOWING PENILE VEIN LIGATION

In an effort to characterize the changes in penile vasculature that oc cur following penile vein ligation, we performed pharmaco-cavernosomet ry and pharmaco-cavernosography on 20 patients after penile vein ligat ion for comparison with preoperative studies. Three patients with retu rn of erectile function underwent repeat study: 2 were completely norm al and 1 had a mild leak from the deep dorsal vein. The remaining 17 p atients had continued complaints of erectile impairment. Of these stud ies 4 showed no evidence of venous leakage, 11 identified a new site o f leakage (7 corporo-spongiosal shunts, 2 crural veins and 2 with mult iple sites of involvement) and 1 revealed persistent leak through the proximal stump of the resected deep dorsal vein, while 1 patient had a n iodine allergy and underwent pharmaco-cavernosometry only. A repeat study in the latter patient showed flow volumes consistent with contin ued venous leakage. In summary, penile vein ligation appears to be eff ective at correcting venous leakage noted on cavernosography. However, new sites of leakage frequently appear postoperatively. A corporospon ginsal shunt was the most frequent site of recurrent venous leakage. A surprisingly high percentage of patients with continued complaints of erectile dysfunction following penile vein ligation demonstrate no ve nous leakage on subsequent pharmaco-cavernosography.