Who is suitable for surgery?
Venous leakage is diagnosed by ultrasound with a pharmacological test (high end-diastolic velocity) and is clarified by dynamic cavernosography, showing the veins through which the blood is “dumped”. The operation is justified in men under 40-45 years of age without arterial insufficiency, diabetes and smoking - then erection improves in 50-70%, the effect lasts for several years. Through a 3–4 cm incision at the base of the penis, the dorsal vein with its tributaries is ligated and intersected, and, if necessary, the pedunculated veins (according to cavernosography). Sexual rest for 4 weeks. If the operation does not help, injections and penile prosthetics remain.
Erectile dysfunction treatment ladder
The first line is PDE-5 inhibitors (tablets) and correction of the causes: testosterone, diabetes, blood pressure, smoking. The second is intracavernosal injections of vasoactive drugs and vacuum devices, which give an erection in 80-90% of men, including those for whom pills do not help. The third is surgery: in case of proven venous leakage in young patients - ligation of the veins, in all other cases - penile prosthesis. Diagnosis begins with ultrasound with Doppler against the background of a pharmacological test, which distinguishes between arterial, venous and psychogenic ED.
Intracavernous therapy
Injection of a drug (papaverine, phentolamine, alprostadil/vasaprostan) into the corpus cavernosum causes an erection within 5–15 minutes, regardless of arousal. The first injection is performed in the clinic as a dose titration test, then the patient is taught self-administration before sexual intercourse (up to 2-3 times a week). The risk is a prolonged erection (priapism) in case of an overdose, so the doctor selects the dose.
