Long-term results of dorsal penile vein ligation for symptomatic treatmentof erectile dysfunction

About 20% of patients with erectile dysfunction do not react to intracavern ous pharmacological treatment (SKAT) because of a cavernous leak. The first attempt to treat venous insufficiency goes back as far as the beginning of the century. Ligature and resection of the superficial and deep veins of t he penis (DPVL) were performed in 122 patients (nonresponders to SKAT with a maintenance flow of less than 40 ml min(-1)). Twenty-four patients suffer ed from primary dysfunction and 98 from secondary dysfunction. The average age of the patients was 49 years, and the average duration of the preoperat ive erectile dysfunction 4.4 years. Postoperative follow-up was carried out for 70 months. In 98% of the patients, cavernosography revealed a dorsal l eak. Twenty-six per cent had ectopic veins, 38% a leakage through the crura l veins and 24% a glandular or spongiosal shunt. After the 70-month follow- up, only 14% of the 122 patients were able to achieve an adequate spontaneo us erection and 19% also responded to SKAT. Depending upon the time elapsed since the operation, the rate of spontaneous reaction was reduced. It was found that younger patients with a short history of erectile dysfunction, n o arterial cofactor, a maintenance flow of less than 100 ml min(-1) and a s evere dorsal leakage from a DPVL were the most likely to benefit from this procedure. Since degeneration of smooth muscle cells of the cavernosa is in most patients the cause of the venous leakage, penis vein surgery is to be regarded as symptomatic treatment.