Ligation of Crura Penis for Impotence Due to Perineal Venous Leakage

Paick, Jae Seung; Lee, Kyu Seung; Kim, Si Whang

Abstract

The 2 venous pathways that assure drainage of the corpora cavernosa are the deep dorsal and the perineal venous pathways. The deep dorsal vein have been investigated but the perineal pathway has received little attention. Recently, attention was focused on the prominent part of the perineal venous system in impotence. In our hospital during last 2 years, 12 consecutive impotent man who failed to achieve an erection after intracorporeal papaverine injection and revealed intact arterial system on Duplex-sonography underwent pharmacocavernosometry -cavernosography. Venous leakage was demonstrated in 12 patients : dorsal in 6, perineal in 4 and dorsal plus perineal leakage in 1. The perineal venous system consists of veins arising from the crural edge of both corpora and ligation of the crura penis seems to be efficient in the treatment of impotence owing to their leakage. We performed ligation of crura penis in two primary erectile impotence patients who was demonstrated perineal venous leakage on cine-cavernosography. Follow-up was approximately 12 months. One patient reported marked improvement in penile rigidity at erection allowing satisfactory intercourse, but another no improvement. Obvious question is whether simple ligation of the veins draining the corpora will correct the impotence in a man with a venous leakage. Therefore further studies on etiologic factors in venous leakage must be performed before definite treatment can be made.