The False Diagnosis of Venous Leak: Prevalence and Predictors

Abstract

Introduction As a vascular test, dynamic infusion cavernosometry (DIC) has lost popularity, and in the urologic community, penile duplex Doppler ultrasound (DUS) has become the sole test to investigate a vascular etiology of erectile dysfunction. Vasoactive agent redosing has been shown to increase the accuracy of DUS. Aim To define the erectile hemodynamics in men with previously diagnosed venous leak on DUS. Methods Prospective data were collected on patients who (i) had been given a diagnosis of venous leak based on an outside DUS; (ii) elected to undergo a repeat DUS; and (iii) when the repeat DUS suggested venous leak, underwent DIC. Main Outcome Measures DUS: peak systolic velocity and end-diastolic velocity. DIC: flow to maintain. Results 292 patients were included. Mean ± standard deviation age was 44 ± 26 years. On repeat DUS, 19% (56/292) had completely normal hemodynamics and 7% (20/292) had arterial insufficiency only without venous leak. DIC revealed normal hemodynamics in 13% (38/292), while in 58% (152/292) of patients, the venous leak diagnosis was confirmed. Overall, 47% (137/292) of patients who had been given a diagnosis of venous leak had completely normal hemodynamics, and in only 43% (126/292), the venous leak diagnosis was confirmed upon repeat vascular testing. On multivariable analysis, younger age (<45 years), failure to obtain an adequate erection during the original DUS, and having <2 vascular risk factors were predictive of a false diagnosis of venous leak. Conclusions Penile DUS has a propensity to inaccurately assign a diagnosis of venous leak. Great care should be taken when performing DUS especially in younger men without a significant vascular risk factor history, and the failure to obtain a good erection should make the clinician cautious in assigning a diagnosis of venous leak. Furthermore, there still exists a role for cavernosometry, which appears to have a greater accuracy at diagnosing venous leak.

Implanted Muscle-Derived Stem Cells Ameliorate Erectile Dysfunction in a Rat Model of Type 2 Diabetes, but Their Repair Capacity Is Impaired by Their Prior Exposure to the Diabetic Milieu

“…The prevalent form of erectile dysfunction in T2D is vasculogenic, presenting mostly as corporal veno-occlusive dysfunction ( CVOD ) (15,16), the loss of compliance of the corporal smooth muscle to relax and compress the veins against the rigid tunica albuginea to retain the blood during an erection. CVOD is essentially a corporal smooth muscle cell ( SMC ) dysfunction caused by SMC loss or damage, compounded by endothelial damage and fibrosis (17).…”

SOP: Corpus Cavernosum Assessment (Cavernosography/Cavernosometry)

“… Moderately invasive Unknown positive predictive value Unknown LR Lack of standardization of the parameter Anxiety/sympathetic overtone might lead to false‐positive results [9]. Up to now, it is not possible to record if there is a complete smooth muscle relaxation even after the intracavernous injection of a vasoactive drug and sexual stimulation [10]. A false‐positive diagnosis results in serious erroneous advice or procedures. …”

“…Up to now, it is not possible to record if there is a complete smooth muscle relaxation even after the intracavernous injection of a vasoactive drug and sexual stimulation [10].…”

Hypertension: The Link Between Erectile Dysfunction and Coronary Artery Disease

“…35 As a result of this aging-related smooth muscle myopathy, the majority of men, regardless of age, when evaluated with sophisticated testing for their complaint of ED, are found to have venous leakage or cavernosal veno-occlusive dysfunction (CVOD). 11,25,36 However, since the ability of a man to attain and then maintain his erection is the result of a dynamic balance between inflow and outflow of blood within the cavernosal bodies, a man experiencing an increase in his…”