Joseph Narus

The False Diagnosis of Venous Leak: Prevalence and Predictors

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.

A review of outcomes of an intracavernosal injection therapy programme

Study Type – Therapy (outcomes research)

Prospective analysis of penile length changes after radical prostatectomy.

To assess the impact of radical prostatectomy (RP) on penile dimensions. To assess the impact of phosphodiesterase‐5 inhibitor (PDE5i) use on penile length changes.

Erectile dysfunction in men treated for testicular cancer

To study the unique characteristics of erectile dysfunction (ED) in a population of men who developed ED after testicular cancer (TC) diagnosis and treatment.

Intracavernosal Injection Training

Intracavernosal injection therapy is a second-line therapeutic approach in the management of erectile dysfunction utilized when oral phosphodiesterase type 5 (PDE5) inhibitors are found to be ineffective or not tolerated due to side effects. First introduced in the 1980s, they are commonly used as part of a penile rehabilitation program in men who have undergone radical pelvic surgery (prostatectomy, cystoprostatectomy). Intracavernosal injection therapy involves the direct injection of alprostadil, phentolamine, and papaverine separately or in combination into the corpus cavernosum of the penis. Appropriately training men in the use of intracavernosal injections will diminish potential complications of therapy, including priapism. Priapism may occur in men who self-adjust their dose or who are not closely monitored. It should be treated as a medical emergency requiring immediate evaluation and intervention.