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The Anatomic Diagnosis of Venous Leak Using CT Cavernosography
Jack Campbell, MD, Mary St. John, BS, Esther L. Finney, MD, Jonathan T. Xu, MD, Alex J. Vanni, MD, Andrew R. McCullough, MD.
Lahey Hospital and Medical Center, Burlington, MA, USA.

Introduction Penile duplex doppler ultrasound (DDUS) has been the gold standard for the evaluation of erectile hemodynamics since the 1980s, however anatomic detail and description is limited. CT cavernosography (CTC) is a new method for evaluating penile hemodynamics and provides a detailed anatomic view of the pathways of venous leak. To date, there has been no standardized anatomic description of penile venous leak erectile dysfunction (ED). The objective of this study is to evaluate patients with EDth erectile dysfunction usingwith CTC, ,describe anatomic variations of venous leak, and compare the diagnosis of venous leak ED on CTC to DDUS.
Materials and Methods Retrospective review was performed for all patients with erectile dysfunction who underwent CTC and DDUS from July 2019 to October 2021. Patient demographics, laboratory data, erectile dysfunction history, imaging, and surgical history were collected. Subgroup analysis was performed on patients found to have venous leak on CTC as well as for patients who had also undergone DDUS. Venous leak on CTC was divided into three anatomical subgroups: superficial (entering the saphenous system), deep (entering the internal iliacs), and spongiosal leak (entering the corpus spongiosum of the urethra).
Results 185 patients with erectile dysfunction underwent evaluation with CTC. 157 (84.9%) were found to have venous leak on CTC. Of this group, 69.4% (109/157) were found to have multiple anatomic types of venous leak, as displayed in Table 1.
Table 1: Anatomic Type of Venous Leak on CTC

Type of Venous LeakN (% out of 157)Type of Venous LeakN (% out of 157)
Superficial Only12 (7.6)Superficial and Spongiosal5 (3.2)
Deep Only32 (20.4)Deep and Spongiosal4 (2.5)
Spongiosal Only4 (2.5)Superficial and Deep59 (37.6)
All three types41 (26.1)

Of the total 185 patients, 62 had also undergone evaluation with DDUS. In totalOf this cohort, 83.9% of these patients were observed to have venous leak by CTC compared to only 33.9% by DDUS. Venous leak was detected on both CTC and DDUS in 25.8% of patients, by CTC but not DDUS in 58.1% of patients, and by DDUS but not CTC in 8.1% of patients (Table 2). . Venous leak was detected by CTC and not by DDUS in 58.1% of patients, whereas venous leak was detected in 8.1% of patients (Table 2).
Table 2: Diagnosis of Venous Leak using CTC and DDUS
(+) Venous Leak DDUS(-) Venous Leak DDUS
(+) Venous Leak CTC16 (25.8%)36 (58.1%)
(-) Venous Leak CTC5 (8.1%)5 (8.1%)

Conclusions CT cavernosography provides substantial anatomic detail regarding veno-occlusive disease in erectile dysfunction compared to DDUS alone. This is the first study to demonstrate multiple anatomic pathways of venous leak which suggests the complexity of veno-occlusive disease has been previously underestimated. A k. This study suggests that a significantly higher proportion of men will be found to have veno-occlusive disease using CTC compared to DDUS, and tand suggests the complexity of veno-occlusive disease has been previously underestimated. While further study is required, these preliminary results raise the possibility of occult venous leak in many men who might be best served by earlier surgical management.

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