Anatomical evaluation of penile venous system by CT cavernosography in patients with erectile dysfunction and venous leakage

Erectile dysfunction is an important problem in men and an organic cause is found in about 50% of cases. When a vasculogenic etiology is suspected, imaging assessments are of great help. Cavernosography is traditionally recognized as an imaging modality for evaluation of venous leakage in men with impotency. We employed CT cavernosography as a novel technique for demonstrating penile venous anatomy and leaking veins. In the present case series study, we recruited 45 patients with erectile dysfunction by convenient sampling at Hazrat Rasoul Akram Hospital in Tehran, Iran, during one year (1390). The patients had previously been diagnosed with venous incompetency by Doppler study. After intracavernosal injection of prostaglandin E1, we injected sterile normal saline into the corpora cavernosa to achieve penile erection. Later, we injected contrast media into the corpus cavernosum, which was followed by CT scan of the penis and pelvic area to show the venous anatomy and leakage sites. The mean age of the patients was 35.8±8.9 years. 36 (80%) patients had venous leakage in crural veins, 27 (60%) in cavernosal veins, 27 (60%) in circumflex veins, 24 (52.3%) in urethral veins, 21 (46.7%) in deep dorsal vein, 3 (6.7%) in para-arterial veins and 3 (6.7%) in corpus spongiosum. The results of this study show the high prevalence of venous leakage in patients referring for erectile dysfunction. Moreover, CT cavernosography was shown to be a useful method for evaluating penile venous system and its related leakage sites which are important for surgical planning.