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Shaeer O, El-Shaarawy EAA, Emam HY, Elsisi I, Sokar E, Shaeer K. Sub-gluteal ligation of the internal pudendal vein for management of veno-occlusive erectile dysfunction (Shaeer's Vein Ligation-I): the cadaveric study. Int J Impot Res 2024:10.1038/s41443-024-00846-1. [PMID: 38424355 DOI: 10.1038/s41443-024-00846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
Vein ligation for veno-occlusive erectile dysfunction is being abandoned due to the recurrence rate. Among the reasons for failure is inability to ligate the deep system of veins; the internal pudendal vein. The vein exits the pelvis in the gluteal region, from the lesser sciatic foramen to the greater sciatic foramen, coursing over the ischial spine and sacro-spinous ligament, under the gluteus maximus. This work aims to verify feasibility of the first surgical procedure to ligate the internal pudendal vein through the gluteal approach. This cadaveric study involved five formalin-fixed cadavers. A surface anatomical landmark was designed to identify the ischial spine, at the intersection of two lines: a vertical line from posterior superior iliac spine to ischial tuberosity, and a horizontal line extending from sacro-coccygeal joint, laterally. An incision is cut encompassing the target point. Subcutaneous fat is dissected down to the gluteus maximus, which is split along the direction of its fibers. The vein can be found crossing over the ischial spine. "Shaeer's Vein Ligation - I" appears to be surgically feasible. A protocol for a surgical study is registered at clinicaltrials.gov, and is open for participation.
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Affiliation(s)
- Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt.
- The Middle East Society for Sexual Medicine, Cairo, Egypt.
| | - Ehab A A El-Shaarawy
- Department of Anatomy and Embryology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Y Emam
- Department of Anatomy and Embryology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Islam Elsisi
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eslam Sokar
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Kamal Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
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Hoppe H, Hirschle D, Schumacher MC, Schönhofen H, Glenck M, Kalka C, Willenberg T, Sixt S, Müller D, Gutzeit A, Christe A, Mohan V, Diehm N. Erectile dysfunction: role of computed tomography cavernosography in the diagnosis and treatment planning of venous leak. CVIR Endovasc 2023; 6:56. [PMID: 37975993 PMCID: PMC10656380 DOI: 10.1186/s42155-023-00403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Venous leak appears to be the most common cause of vasculogenic erectile dysfunction (ED), which can be treated with venous embolization. Traditionally, conventional cavernosography was used for the diagnosis and treatment planning of venous leak. Recently, computed tomography (CT) cavernosography was introduced as a novel cross-sectional imaging method proposed to be advantageous over conventional cavernosography. We created a novel management algorithm for diagnosing venous leak including CT cavernosography as an imaging modality. In order to provide a broader basis for our management algorithm, a systematic literature review was conducted. MAIN BODY In this article we systematically review relevant literature on using CT cavernosography for the diagnosis and treatment planning in ED patients with venous leak following the PRISMA selection process. Nine full-text articles were included in the review and assigned a level of evidence grade (all grade II). Two studies (2/9) compared the results of conventional cavernosography with those of CT cavernosography which was superior for site-specific venous leak identification (19.4% vs. 100%, respectively). CT cavernosography is a more detailed imaging method that is faster to perform, exposes the patient to less radiation, and requires less contrast material. In one study (1/9), CT cavernosography was used for diagnostic purposes only. Eight studies (8/9) cover both, diagnostic imaging and treatment planning including embolization (1/9) and sclerotherapy (2/9) of venous leak in patients with venogenic ED. Three studies (3/9) describe anatomical venous leak classifications that were established based on CT cavernosography findings for accurate mapping of superficial and/or deep venous leak and identification of mixed or more complex forms of venous leak present in up to 84% of patients. In addition to treatment planning, one study (1/9) used CT cavernosography also for follow-up imaging post treatment. CONCLUSION CT cavernosography is superior to conventional cavernosography for diagnosis and treatment planning in patients with ED caused by venous leak (grade II levels of evidence). Consequently, CT cavernosography should be included in management algorithms for ED patients with suspected venous leak.
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Affiliation(s)
- Hanno Hoppe
- University of Bern, Bern, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
- Microtherapy Center Bern, Lindenhofspital, Bern, Switzerland.
- Campus Stiftung Lindenhof Bern, Bern, Switzerland.
| | | | | | | | - Michael Glenck
- Microtherapy Center Bern, Lindenhofspital, Bern, Switzerland
| | | | - Torsten Willenberg
- University of Bern, Bern, Switzerland
- Vascular Center Bern, Lindenhofspital, Bern, Switzerland
| | | | | | - Andreas Gutzeit
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Andreas Christe
- Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Vignes Mohan
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | - Nicolas Diehm
- University of Bern, Bern, Switzerland
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Applied Sciences Furtwangen, Villingen-Schwenningen, Germany
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Diehm N, Pelz S, Kalka C, Keo HH, Mohan V, Schumacher MC, Do DD, Hoppe H. Venous Leak Embolization in Patients with Venogenic Erectile Dysfunction via Deep Dorsal Penile Vein Access: Safety and Early Efficacy. Cardiovasc Intervent Radiol 2023; 46:610-616. [PMID: 36949182 PMCID: PMC10156837 DOI: 10.1007/s00270-023-03412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/28/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE This all-comers registry aimed to assess safety and early efficacy of venous embolization in patients with venogenic erectile dysfunction due to venous leak in an unselected cohort. METHODS Between October 2019 and September 2022, patients with venogenic erectile dysfunction resistant to phosphodiesterase-5-inhibitors were treated with venous embolization using ultrasound-guided anterograde access via a deep dorsal penile vein in a single center. A mix of ethiodized oil and modified cyanoacrylate-based glue n-butyl 2 cyanoacrylate (NBCA) monomer plus methacryloxy-sulpholane monomer (Glubran-2, GEM, Italy) was used as liquid embolic agent. Prior to embolization, venous leak had been verified based on penile duplex sonography and computed tomography cavernosography. Procedural success was defined as technically successful and complete target vein embolization. The primary safety outcome measure was any major adverse event 6 weeks after the procedure. The primary feasibility outcome measure was IIEF-15 (International Index of Erectile Function-15) score improvement ≥ 4 points in ≥ 50% of subjects on 6 weeks follow-up post intervention. RESULTS Fifty consecutive patients (mean age 61.8 ± 10.0 years) with severe erectile dysfunction due to venous leak underwent venous embolization. Procedural success was achieved in 49/50 (98%) of patients with no major adverse events on follow-up. The primary feasibility outcome measure at 6 weeks was reached by 34/50 (68%) of patients. CONCLUSION Venous leak embolization via deep dorsal penile vein access using a liquid embolic agent was safe for all and efficacious in the majority of patients with severe venogenic erectile dysfunction on 6 weeks follow-up.
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Affiliation(s)
- N Diehm
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Applied Sciences Furtwangen, Villingen-Schwenningen, Germany
- University of Bern, Bern, Switzerland
| | - S Pelz
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Bern, Bern, Switzerland
| | - C Kalka
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | - H H Keo
- Vascular Institute Central Switzerland, Aarau, Switzerland
- Department of Angiology, University Hospital of Basel, Basel, Switzerland
| | - V Mohan
- Vascular Institute Central Switzerland, Aarau, Switzerland
| | - M C Schumacher
- Department of Urology, Hirslanden Clinic Aarau, Aarau, Switzerland
| | - D D Do
- Vascular Institute Central Switzerland, Aarau, Switzerland
- University of Bern, Bern, Switzerland
| | - H Hoppe
- University of Bern, Bern, Switzerland.
- SwissIntervention Microtherapy Center, Bern, Switzerland.
- Campus Stiftung Lindenhof Bern, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland.
- University of Lucerne, Lucerne, Switzerland.
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Hoppe H, Diehm N. To the editor-an update on endovascular treatment of venogenic erectile dysfunction. CVIR Endovasc 2022; 5:30. [PMID: 35764900 PMCID: PMC9240174 DOI: 10.1186/s42155-022-00310-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/17/2022] [Indexed: 11/19/2022] Open
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