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'''Venous Leak''', also called Venogenic Erectile Dysfunction and Penile Venous Insufficiency, is a cause of [[Erectile Dysfunction]] in males,<ref>{{cite journal | title=Intracavernosal vascular endothelial growth factor (VEGF) injection and adeno-associated virus-mediated VEGF gene therapy prevent and reverse venogenic erectile dysfunction in rats. |vauthors=Rogers RS, etal | journal=Int J Impot Res. |date=Feb 2003 | volume=15 | issue=1 | pages=26–37 | PMID=12605238 | doi=10.1038/sj.ijir.3900943}}</ref> often afflicting ''young men'', unlike other organic causes of Erectile Dysfunction. Much about the venous leaks is still unknown and many aspects of the condition are highly controversial among the medical community. Medical Professionals likely to come across Venous Leaks are [[General Practitioners]], [[Urologists]], [[Andrologist]]s, Psychiatrists, [[Endocrinologist]]s and Radiologists. The prevalence of the condition is still very much unknown, although some sources claim it to be a common cause of Erectile Dysfunction. |
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| synonyms = Venogenic erectile dysfunction, penile venous insufficiency |
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'''Venous leak''', also called '''venogenic erectile dysfunction''', '''penile venous insufficiency''', and veno-occlusive erectile dysfunction, is one category of vasculogenic impotence -a cause of [[erectile dysfunction]] in males.<ref>{{cite journal | title=Intracavernosal vascular endothelial growth factor (VEGF) injection and adeno-associated virus-mediated VEGF gene therapy prevent and reverse venogenic erectile dysfunction in rats. |vauthors=Rogers RS, etal | journal=Int J Impot Res. |date=Feb 2003 | volume=15 | issue=1 | pages=26–37 | pmid=12605238 | doi=10.1038/sj.ijir.3900943}}</ref><ref name="Vascular Surgery for Erectile Dysfunction, Encyclopedia of Reproduction">{{cite web|url=http://dx.doi.org/10.1016/B978-0-12-801238-3.64804-3|title=Vascular Surgery for Erectile Dysfunction|publisher= Academic Press}}</ref> It affects all ages, being particularly awkward in young men.<ref name="Parona F 1873. Imperfect penile ... 71-76">{{cite web|url=http://tuleoffice.com/images/editor/File/pdf/book/IMPOTENCY/5%20(6).pdf|title= Parona F.1873.Imperfect penile erection due to varicosity of the dorsal vein: observation. Giornale Italiano. 14: 71-76|publisher=}}</ref> Much about venous leaks has not reached a consensus among the medical community, and many aspects of the condition, particularly its treatment strategies, are controversial. The prevalence of the condition is still unknown, although some sources claim it to be a common cause of erectile dysfunction.<ref name="Fuchs AM, et al. 1989. Anatomy ... 1353–1356">{{cite journal|title= Fuchs AM, et al. 1989. Anatomy of penile venous drainage in potent and impotent men during cavernosography. J Urol. 141(6): 1353–1356.|journal=Arzneimittel-Forschung|volume=25|issue=9|pages=1369–79|publisher=|pmid = 22|year = 1975|last1 = Ardenne|first1 = M.|last2=Reitnauer|first2=P. G.}}</ref> |
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==Signs and symptoms== |
==Signs and symptoms== |
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Many men with Venogenic Erectile Dysfunction start having trouble with their erections from a young age.<ref name="Chen SC, et al. Jan 2005. The progression of the penile vein: could it be recurrent? J Androl. 26(1): 56-63.">{{cite journal|title=Chen SC, et al. Jan 2005. The progression of the penile vein: could it be recurrent? J Androl. 26(1): 56-63.|journal=Journal of Andrology|volume=26|issue=1|pages=53–60|publisher=|pmid = 15611567|year = 2005|last1 = Chen|first1 = S. C.|last2=Hsieh|first2=C. H.|last3=Hsu|first3=G. L.|last4=Wang|first4=C. J.|last5=Wen|first5=H. S.|last6=Ling|first6=P. Y.|last7=Huang|first7=H. M.|last8=Tseng|first8=G. F.}}</ref> Common complaints include a chronic soft erection insufficient for sexual intercourse, position-dependent erectile rigidity, difficulty achieving erections, difficulty maintaining erections without constant manual stimulation, loss of penile length and girth, and a soft [[glans]] of the penis during erection that is not fully engorged.<ref name="Vascular Surgery for Erectile Dysfunction, Encyclopedia of Reproduction">{{cite web|url=http://dx.doi.org/10.1016/B978-0-12-801238-3.64804-3|title=Vascular Surgery for Erectile Dysfunction|publisher= Academic Press}}</ref> |
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Physicians often look for signs that suggest an organic cause of erectile dysfunction rather than a psycho-osmotic cause in making a diagnosis of Venous Leak. Such suggestive signs include (1) Erectile Dysfunction that is persistent on all occasions where an erection is required, including with a partner and without a partner during masturbation, (2) Loss of quality of |
Physicians often look for signs that suggest an organic cause of erectile dysfunction rather than a psycho-osmotic cause in making a diagnosis of Venous Leak. Such suggestive signs include (1) Erectile Dysfunction that is persistent on all occasions where an erection is required, including with a partner and without a partner during masturbation, (2) Loss of quality of morning Erections, (3) Loss of quality of spontaneous erections, and (4) multi-treatment resistance to traditional erectile dysfunction medications including [[sildenafil]] and cavernosal injection therapy.<ref name="Vascular Surgery for Erectile Dysfunction, Encyclopedia of Reproduction">{{cite web|url=http://dx.doi.org/10.1016/B978-0-12-801238-3.64804-3|title=Vascular Surgery for Erectile Dysfunction|publisher= Academic Press}}</ref> |
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==Causes== |
==Causes== |
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Venous Leak is an inability to maintain an erection in the presence of sufficient arterial blood flow through the cavernosal arteries of the penis. The defect lies in the drainage of the cavernosal tissue of the penis, which |
Venous Leak is an inability to maintain an erection in the presence of sufficient arterial blood flow through the cavernosal arteries of the penis.<ref name="Penis Structure-Erection, Encyclopedia of Reproduction">{{cite web|url=http://dx.doi.org/10.1016/B978-0-12-801238-3.64603-2|title=Penis Structure-Erection|publisher= Academic Press}}</ref><ref name="Hsu GL, et al. Dec 2013 Reconstructive surgery ... 375–383">{{cite journal|title=Hsu GL, et al. Dec 2013 Reconstructive surgery for idealizing penile shape and erectile functional restoration on patients with penile dysmorphology and erectile dysfunction. Arab J Urol. 11(4):375–383|journal=Arab Journal of Urology|volume=11|issue=4|pages=375–383|publisher=|pmc = 4442992|year = 2013|last1 = Hsu|first1 = G. L.|last2=Molodysky|first2=E.|last3=Liu|first3=S. P.|last4=Chang|first4=H. C.|last5=Hsieh|first5=C. H.|last6=Hsu|first6=C. Y.|pmid=26558108|doi=10.1016/j.aju.2013.08.009}}</ref> The defect lies in the excessive drainage of veins in the cavernosal tissue of the penis, which undermines normal erectile function. This provides extraordinary venous drainage from the corpora cavernosa of the penis despite the existence of a rigid erection and fails to adequately trap blood inside the corporeal chambers to maintain an erection of adequate strength or adequate length of time. It is still disputed as to what causes the excessive leakiness that is characteristic of the condition. However, it is mostly thought that the defect is in the connective tissue of the [[tunica albuginea (penis)|tunica albuginea]] surrounding the penile veins (most importantly, one Deep Dorsal Vein of the penis, a pair of cavernosal veins, and two pairs of para-arterial veins, which are collectively coined "the erection-related veins" by Dr. [[Geng Long Hsu]], between the Buck's fascia and the tunica albuginea of the penis).<ref name="Hsu GL, et al. Aug 2018. ... 64602-0">{{cite book|chapter-url=https://www.elsevier.com/books/encyclopedia-of-reproduction/skinner/978-0-12-811899-3|title=M. K. Skinner (Ed.), Encyclopedia of Reproduction. vol. 1, pp. 357–366. Academic Press: Elsevier. http://dx.doi.org/10.1016/B978-0-12-801238-3.64602-0|pages=357–366|publisher=|doi=10.1016/B978-0-12-801238-3.64602-0|chapter=Penis Structure|year=2018|last1=Hsu|first1=Geng-Long|last2=Liu|first2=Shih-Ping|isbn=9780128151457}}</ref> |
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[[File:Hsu Fig 1.jpg|thumb|Arrow point the drainage veins, arrowheads denote a 19G scalp needle and hollow star locates the corpora cavernosa]] |
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Other possible causes; |
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- Trauma |
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Recently hemodynamic studies were conducted in both fresh and defrosted human cadavers in which a rigid erection was without exception attainable despite cavernosal tissue having lost its extensibility in cadaveric sinusoids. This implies a rigid penile erection is just a mechanical event and, consequently, that penile veins play a pivotal role in achieving a rigid erection. This is clearly a ramification of endorsing the determinant role of the erection-related veins in human erectile function.<ref>{{cite journal | title= 死人也能勃起 |vauthors=Hsu | journal= World Journal |date= March 2011 | volume= | issue=3–27 | pages=A2 | pmid= }}</ref> {{ums}} |
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- Testosterone Deficiency |
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- Prostate Resection Surgery |
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Furthermore, cavernosograms demonstrate that excessively leaky veins can cause drainage of the corpora cavernosa. Histological specimens of cavernosal tissue in patients with confirmed veno-occlusive disorder show changes in the structure of collagen and elastin making up the connective tissue of the penis when compared to a control group.<ref name="Hsu GL, et al. Aug 2018. ... 64602-0">{{cite book|chapter-url=https://www.elsevier.com/books/encyclopedia-of-reproduction/skinner/978-0-12-811899-3|title=M. K. Skinner (Ed.), Encyclopedia of Reproduction. vol. 1, pp. 357–366. Academic Press: Elsevier. http://dx.doi.org/10.1016/B978-0-12-801238-3.64602-0|pages=357–366|publisher=|doi=10.1016/B978-0-12-801238-3.64602-0|chapter=Penis Structure|year=2018|last1=Hsu|first1=Geng-Long|last2=Liu|first2=Shih-Ping|isbn=9780128151457}}</ref> These changes may be responsible for such symptoms. In addition, other possible causes include psychological stress, testosterone deficiency, neurotic deficit, a drug’s adverse influence, iatrogenic, and chronic systemic diseases such as diabetes and low urinary tract symptoms.<ref name="Hsu GL, et al. Aug 2018. ... 64602-0">{{cite book|chapter-url=https://www.elsevier.com/books/encyclopedia-of-reproduction/skinner/978-0-12-811899-3|title=M. K. Skinner (Ed.), Encyclopedia of Reproduction. vol. 1, pp. 357–366. Academic Press: Elsevier. http://dx.doi.org/10.1016/B978-0-12-801238-3.64602-0|pages=357–366|publisher=|doi=10.1016/B978-0-12-801238-3.64602-0|chapter=Penis Structure|year=2018|last1=Hsu|first1=Geng-Long|last2=Liu|first2=Shih-Ping|isbn=9780128151457}}</ref> |
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==Treatment== |
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Since 1873, when a hypertonic solution was injected into the large penile vein in an attempt to treat impotence and resulting in reduced venous drainage away from the corpora cavernosa, there has been much controversy concerning the most ideal milieu for applying Pascal’s law as it relates to this area of study.<ref name="Hsu GL, et al. Aug 2018. ... 64602-0">{{cite book|chapter-url=https://www.elsevier.com/books/encyclopedia-of-reproduction/skinner/978-0-12-811899-3|title=M. K. Skinner (Ed.), Encyclopedia of Reproduction. vol. 1, pp. 357–366. Academic Press: Elsevier. http://dx.doi.org/10.1016/B978-0-12-801238-3.64602-0|pages=357–366|publisher=|doi=10.1016/B978-0-12-801238-3.64602-0|chapter=Penis Structure|year=2018|last1=Hsu|first1=Geng-Long|last2=Liu|first2=Shih-Ping|isbn=9780128151457}}</ref> |
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Because many males are not responding to standard medical therapy (including PDE-5 inhibitor, intracavernosal injection therapy, and coil embolization etc), a penile venous stripping seems to be a unique treatment (Figure 1B). Nevertheless, for those with erectile dysfunction that remains resistant to less-invasive treatments, penile implant remains the final solution.<ref name="Penile Prosthesis for Erectile Dysfunction, Encyclopedia of Reproduction">{{cite web|url=https://www.sciencedirect.com/science/article/pii/B9780128012383648031|title=Penile Prosthesis for Erectile Dysfunction|publisher= Academic Press}}</ref><ref>{{cite web|last1=Perito|first1=Paul|title=Penile Implants|url=http://www.peritourology.com/penile-implants/|website=PeritoUrology.com|publisher=Perito Urology|accessdate=18 November 2014}}</ref> |
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==References== |
==References== |
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{{reflist}} |
{{reflist}} |
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[[Category:Penile erection]] |
[[Category:Penile erection]] |
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[[Category:Human penis]] |
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[[Category:Urology]] |
Revision as of 03:29, 9 April 2019
Venous leak | |
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Other names | Venogenic erectile dysfunction, penile venous insufficiency |
Venous leak, also called venogenic erectile dysfunction, penile venous insufficiency, and veno-occlusive erectile dysfunction, is one category of vasculogenic impotence -a cause of erectile dysfunction in males.[1][2] It affects all ages, being particularly awkward in young men.[3] Much about venous leaks has not reached a consensus among the medical community, and many aspects of the condition, particularly its treatment strategies, are controversial. The prevalence of the condition is still unknown, although some sources claim it to be a common cause of erectile dysfunction.[4]
Signs and symptoms
Many men with Venogenic Erectile Dysfunction start having trouble with their erections from a young age.[5] Common complaints include a chronic soft erection insufficient for sexual intercourse, position-dependent erectile rigidity, difficulty achieving erections, difficulty maintaining erections without constant manual stimulation, loss of penile length and girth, and a soft glans of the penis during erection that is not fully engorged.[2]
Physicians often look for signs that suggest an organic cause of erectile dysfunction rather than a psycho-osmotic cause in making a diagnosis of Venous Leak. Such suggestive signs include (1) Erectile Dysfunction that is persistent on all occasions where an erection is required, including with a partner and without a partner during masturbation, (2) Loss of quality of morning Erections, (3) Loss of quality of spontaneous erections, and (4) multi-treatment resistance to traditional erectile dysfunction medications including sildenafil and cavernosal injection therapy.[2]
Causes
Venous Leak is an inability to maintain an erection in the presence of sufficient arterial blood flow through the cavernosal arteries of the penis.[6][7] The defect lies in the excessive drainage of veins in the cavernosal tissue of the penis, which undermines normal erectile function. This provides extraordinary venous drainage from the corpora cavernosa of the penis despite the existence of a rigid erection and fails to adequately trap blood inside the corporeal chambers to maintain an erection of adequate strength or adequate length of time. It is still disputed as to what causes the excessive leakiness that is characteristic of the condition. However, it is mostly thought that the defect is in the connective tissue of the tunica albuginea surrounding the penile veins (most importantly, one Deep Dorsal Vein of the penis, a pair of cavernosal veins, and two pairs of para-arterial veins, which are collectively coined "the erection-related veins" by Dr. Geng Long Hsu, between the Buck's fascia and the tunica albuginea of the penis).[8]
Recently hemodynamic studies were conducted in both fresh and defrosted human cadavers in which a rigid erection was without exception attainable despite cavernosal tissue having lost its extensibility in cadaveric sinusoids. This implies a rigid penile erection is just a mechanical event and, consequently, that penile veins play a pivotal role in achieving a rigid erection. This is clearly a ramification of endorsing the determinant role of the erection-related veins in human erectile function.[9] [unreliable medical source?]
Furthermore, cavernosograms demonstrate that excessively leaky veins can cause drainage of the corpora cavernosa. Histological specimens of cavernosal tissue in patients with confirmed veno-occlusive disorder show changes in the structure of collagen and elastin making up the connective tissue of the penis when compared to a control group.[8] These changes may be responsible for such symptoms. In addition, other possible causes include psychological stress, testosterone deficiency, neurotic deficit, a drug’s adverse influence, iatrogenic, and chronic systemic diseases such as diabetes and low urinary tract symptoms.[8]
Treatment
Since 1873, when a hypertonic solution was injected into the large penile vein in an attempt to treat impotence and resulting in reduced venous drainage away from the corpora cavernosa, there has been much controversy concerning the most ideal milieu for applying Pascal’s law as it relates to this area of study.[8]
Because many males are not responding to standard medical therapy (including PDE-5 inhibitor, intracavernosal injection therapy, and coil embolization etc), a penile venous stripping seems to be a unique treatment (Figure 1B). Nevertheless, for those with erectile dysfunction that remains resistant to less-invasive treatments, penile implant remains the final solution.[10][11]
References
- ^ Rogers RS, et al. (Feb 2003). "Intracavernosal vascular endothelial growth factor (VEGF) injection and adeno-associated virus-mediated VEGF gene therapy prevent and reverse venogenic erectile dysfunction in rats". Int J Impot Res. 15 (1): 26–37. doi:10.1038/sj.ijir.3900943. PMID 12605238.
- ^ a b c "Vascular Surgery for Erectile Dysfunction". Academic Press.
- ^ "Parona F.1873.Imperfect penile erection due to varicosity of the dorsal vein: observation. Giornale Italiano. 14: 71-76" (PDF).
- ^ Ardenne, M.; Reitnauer, P. G. (1975). "Fuchs AM, et al. 1989. Anatomy of penile venous drainage in potent and impotent men during cavernosography. J Urol. 141(6): 1353–1356". Arzneimittel-Forschung. 25 (9): 1369–79. PMID 22.
- ^ Chen, S. C.; Hsieh, C. H.; Hsu, G. L.; Wang, C. J.; Wen, H. S.; Ling, P. Y.; Huang, H. M.; Tseng, G. F. (2005). "Chen SC, et al. Jan 2005. The progression of the penile vein: could it be recurrent? J Androl. 26(1): 56-63". Journal of Andrology. 26 (1): 53–60. PMID 15611567.
- ^ "Penis Structure-Erection". Academic Press.
- ^ Hsu, G. L.; Molodysky, E.; Liu, S. P.; Chang, H. C.; Hsieh, C. H.; Hsu, C. Y. (2013). "Hsu GL, et al. Dec 2013 Reconstructive surgery for idealizing penile shape and erectile functional restoration on patients with penile dysmorphology and erectile dysfunction. Arab J Urol. 11(4):375–383". Arab Journal of Urology. 11 (4): 375–383. doi:10.1016/j.aju.2013.08.009. PMC 4442992. PMID 26558108.
- ^ a b c d Hsu, Geng-Long; Liu, Shih-Ping (2018). "Penis Structure". M. K. Skinner (Ed.), Encyclopedia of Reproduction. vol. 1, pp. 357–366. Academic Press: Elsevier. http://dx.doi.org/10.1016/B978-0-12-801238-3.64602-0. pp. 357–366. doi:10.1016/B978-0-12-801238-3.64602-0. ISBN 9780128151457.
- ^ Hsu (March 2011). "死人也能勃起". World Journal (3–27): A2.
- ^ "Penile Prosthesis for Erectile Dysfunction". Academic Press.
- ^ Perito, Paul. "Penile Implants". PeritoUrology.com. Perito Urology. Retrieved 18 November 2014.