To accurately diagnose the venous form of dysfunction, it is recommended to use ultrasound of the penis and scrotum with Doppler ultrasound. If the venous form is suspected after examining the penis in a calm state, it is recommended to inject 20mkg alprostadil, wait for an erection and perform a second ultrasound. In this mode, it is important to study not only the speed of blood flow through the arterial vessels, but also the resistance index, as well as the speed of blood flow through the penile and deep dorsal veins. If, in a state of partial tumescence, the blood flow velocity in the veins exceeds 5 cm/s, then the presence of venous leakage can be assumed. Ultrasound specialists can determine the type of venous leak (proximal or distal) and for more accurate information it is recommended to perform cavernosography or 3D penile computed tomography. These methods allow us to determine the type of venous leak and predict the optimal type of operation.
For proximal leaks, we locate and ligate subcutaneous pathological shunts and perform Marmara microsurgery for varicocele that is often combined with venous leak. With a distal discharge, we perform an x-ray endovascular surgical operation by passing a conductor through the deep dorsal vein and closing the pathological leak in the deep pelvic vein system with metal coils (embolization). 5 days after surgery, patients return to normal sexual activity. The effectiveness of such operations is very high, 80-85% in the first six months after ligation operations, and then it decreases somewhat due to the development of collaterals and is about 50% after 5 years.
To increase the effectiveness and long-term effectiveness of veno-occlusive surgeries, we combine them with the introduction of autologous stem cells into the ligated veins. Moving to the intrathecal spaces of the cavernous bodies – the obturator mechanism that maintains an erection, stem cells contribute to the proliferation of valves and the reconstruction of the veno-occlusive apparatus of erection. Subsequent injections or VEGF injections, Shock-Wave Therapy promote neoangiogenesis and the growth of new afferent vessels, which allows stabilizing an erection.
In addition, it is necessary to exclude all other factors that negatively affect erection: trichomonas or mycoplasma prostatitis, psychological stress, poor sleep, problems with a partner, smoking, abuse of psychoactive or narcotic drugs, etc.
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profknigavko@gmail.com