Archive for June, 2014

Venous Leak

I tell patients to think of their penis like a tire, with a hose and a valve being present. The hoses are represented by the left and right cavernosal artery while the valve mechanism is the veno-occlusive mechanism. Positioned between a tunica albuginea externally and the corporal smooth muscle internally are a series of subtunical venules. As the smooth muscle expands in a three-dimensional fashion under nitric oxide control, the subtunical venules are compressed against the tunica. This is the venoocclusive mechanism. In condi-tions where the muscle fails to expand adequately some or all of the subtunical venules are left in a noncompressed state, and this results in the concept we know as venous leak (synonyms: corporo venocclusive dysfunction, venogenic erectile dysfunction). The two things that lead to failure of the corporal smooth muscle to expand are adrenaline, the world’s most potent antierection chemical and structural changes such as fibrosis. Priligy Australia – dapoxetine online.

Nehra et al. have shown in human corporal tissue biopsy taken at the time of cavernosome try that once smooth muscle content in the penis drops below 40% venous leak occurs. Indeed, the further this figure dropped below 40%, the greater the magnitude of leak is. Iacono et al. have shown that as early as 2 months after radical prostatectomy in an untreated man there is a marked increase in collagen deposition and a marked increase in elastic fiber content in erectile tissue. This is in keeping with the animal data outlined above that suggest even in the earliest stages after cavernous nerve injury, structural changes occur. Mulhall et al. have shown in a series of 16 patients who had preoperative and postoperative hemodynamic assessment that more than half of the men had venous after surgery. In a more recent analysis by Mulhall et al., in men who had partner corroborated excellent erectile function prior to surgery, who underwent duplex Doppler penile ultrasound after surgery, there was an increase in the incidence of venous leak (based on elevated and diastolic velocities) as time progressed after surgery. The incidence of venous leak less than 4 months after surgery was approximately 10% and rose to 35% between 8 and 12 months after surgery and 50% after 12 months. The importance of this information is that in the same series, men with normal erectile hemodynamics were more likely to have recovery of natural erectile function. However, only 8% of men who had venous leak had recovery of natural functional erections after surgery. We also know from other data that men with venous leak are far less likely to respond to PDE5 inhibitors than men with arterial insufficiency.