SELECTIVE VENOUS EMBOLIZATION FOR TREATMENT OF VENOGENIC ERECTILE DYSFUNCTION

Erectile dysfunction is a common disorder in aging men, and venogenic ED is among the most common subtypes. Vein surgery for ED has become less common with increased prevalence of pharmaceutical and prosthetic surgery as well as previous disappointing results, however the advent of interventional radiology and selective venous embolization may be a promising new avenue. We present a case of a man with venogenic ED who underwent selective embolization with significant improvement in erectile function. A 65-year-old man presented complaining of severe erectile dysfunction following prostatectomy 11 years prior, resistant to oral PDE-5 inhibitors and intracavernosal injections. Penile doppler confirmed good arterial inflow with severe venous leak, and cavernosometry and cavernosography confirmed leak from both superficial and intermediate veins. He underwent selective embolization of the external and internal pudendal veins bilaterally by interventional radiology. At 6 weeks post-procedure, patient reported significant improvement in erectile function, with spontaneous erections at 65% rigidity and full tumescence with small volumes of trimix. He did have an initial complication of severe hemorrhoids which resolved spontaneously after several weeks. His erectile improvement was stable at 10 months post-procedure.