Venous leak ligation (Dr. Natalio Cruz)

[Juerhareb]

Hello, I want to ask if anyone knows if there is any possibility of this to work. The doctor claims to be able to fix around 1/3 of selected patients with venous leak by previously analysing by a 3D angiography the exact point of leak and performing a ligation of the necessary veins in case that the venous leak is not a very serious one.

[dg_moore]

A search in FrankTalk returns over 2300 references to venous leak. I can't remember seeing a single one that reports any lasting success through surgical or other interventions.

[wolfpacker]

Concur with dg_moore, seems like it could work in theory but the reality is that it just seems to not be a viable technique to restore function.

[Stenlie_]

Hello, As far as I learned from doctors and literature, congenital venous leakage can not be solved with surgery and ligation. But, as far as I understand, a traumatic shunt or venous leak can give good results. Because you have never had a venous leak, there is no reason for recurrence. Or am I wrong?

[Juerhareb]

The doctor himself claims that between a third of the patients previously selected it works most of the times. In the Internet there are a los some studies which claims to have a decente success rate. Dos you Think this Is all a lie? Is it really worth for a Europa reputated doctor to risk their reputation and evento to legal represalies lying for some patients?

[wolfpacker]

I would love to be proven wrong, but despite claims of success from doctors such as Dr Cruz, I have never seen anyone online say that their ED was significantly improved from this type of procedure. If you get this veinous leak litigation surgery, please report back on whether it helped you or not!

[Juerhareb]

I would love to be proven wrong, but despite claims of success from doctors such as Dr Cruz, I have never seen anyone online say that their ED was significantly improved from this type of procedure. If you get this veinous leak litigation surgery, please report back on whether it helped you or not!

Yes, if I decide to take it I will inform about the results here.

[Simbarn]

Hello, I want to ask if anyone knows if there is any possibility of this to work. The doctor claims to be able to fix around 1/3 of selected patients with venous leak by previously analysing by a 3D angiography the exact point of leak and performing a ligation of the necessary veins in case that the venous leak is not a very serious one.

These are my thoughts on your post.
In order to help answer your question, the definition of what a venous leak is needs to be made, as there seems to be some confusion or lack of understanding about it.

Venous leak is synonymous with the term CVOD. This stands for corporal veno-occlusive dysfunction. This means that there is a dysfunction in the ability of the penis to hold sufficient blood in its erectile bodies (the two corpus cavernosum) to maintain a rigid erection.
Now this is where it gets complex; this dysfunction can have a multitude of causes. It can be almost any breakdown in erectile function, as all components of erectile function contribute to venous occlusion. The penis needs to be able to reduce blood outflow at the point of the tunica albuginea (the tough elastic tissue that encircles the two erectile bodies) at just the right amount so pressure can be maintained. When you understand how many things are working together to enable this, you begin to understand that if one of these processes fail or become erratic, the entire process is compromised. Pressure then drops in the two corpus cavernosum and the seal at the tunica albuginea is less effective.
There is a long list of etiologies that can be included in CVOD, the one that could in my opinion be treated by surgery is a venous shunt; a deformity in the venous network leaving the corpus cavernosum and traveling through the tunica albuginea. This I feel is the only cause of venous leak or CVOD that could be solved by this type surgery. The issue that I see with this in the past is seeing this correctly with imaging methods, being able to clearly identify the problem. If there are other co-existing causes of CVOD present or a number of these deformities which are difficult to see, the surgery will most likely fail.
Previously, vein ligation surgery in the penis has just tried to reduce the outflow of blood from the penis by removing some of the veins on the outside of the tunica albuginea, without fully knowing what is actually causing the venous leak. This has had a high failure rate as over time the veins that are left most probably compensate and the main issue of the failure of the seal at the point of the tunica albuginea has not been addressed.
So, if this 3d angiography is capable of seeing a deformity in the venous network leaving the critical area mentioned above, and the surgeon was experienced and clever enough, the surgery may have a chance of being successful. The problem I see is that some of these veins, such as the emissary veins leaving through the tunica are so fine that any issue with these could be very difficult to detect, and it could be quite possible if there was an issue with one, there could be issues with a number of them, or it could be an issue with tunica albuginea itself, not being able to compress the subtunical venous plexus sufficiently and or a series of the emissary veins.
I would ask the doctor if he can show you the exact issue with regard to the 3d angiography? Where the deformity is and why it is causing the failure. Get him to explain it to you so you understand it fully. Write it down so you don’t forget, as you will.

The one thing you have on your side is your age. Some of the things that may cause CVOD are much more likely to be the result of aging and or lifestyle. Hence why having such surgery as an older person would be more prone to failure as there would most likely be a number of issues contributing to venous leakage, such as endothelial damage, smooth muscle loss and fibrosis.

This doctor has been mentioned a number of times on the forum:
https://doctorpaduch.com/venous-leak-mra/

He uses a technique called dynamic magnetic resonance angiography. Is this the same as the 3d angiography that your doctor is using?

Does your doctor have any patients who have had the surgery and are willing to talk to you about their experience? How well the treatment has held up over a given period of time? The age of these patients?
Always remember the doctor is working for you, not the other way around. Don’t be afraid to ask all the questions you want to, as you are paying them to answer those questions and prove they are capable of doing what they say they can do. This is even more important given that he is performing a type of surgery that in not mainstream and generally not considered viable by most specialists.
Please keep us informed as I think everyone would be interested to hear what you find out!

[Juerhareb]

Hello, I want to ask if anyone knows if there is any possibility of this to work. The doctor claims to be able to fix around 1/3 of selected patients with venous leak by previously analysing by a 3D angiography the exact point of leak and performing a ligation of the necessary veins in case that the venous leak is not a very serious one.

These are my thoughts on your post.
In order to help answer your question, the definition of what a venous leak is needs to be made, as there seems to be some confusion or lack of understanding about it.

Venous leak is synonymous with the term CVOD. This stands for corporal veno-occlusive dysfunction. This means that there is a dysfunction in the ability of the penis to hold sufficient blood in its erectile bodies (the two corpus cavernosum) to maintain a rigid erection.
Now this is where it gets complex; this dysfunction can have a multitude of causes. It can be almost any breakdown in erectile function, as all components of erectile function contribute to venous occlusion. The penis needs to be able to reduce blood outflow at the point of the tunica albuginea (the tough elastic tissue that encircles the two erectile bodies) at just the right amount so pressure can be maintained. When you understand how many things are working together to enable this, you begin to understand that if one of these processes fail or become erratic, the entire process is compromised. Pressure then drops in the two corpus cavernosum and the seal at the tunica albuginea is less effective.
There is a long list of etiologies that can be included in CVOD, the one that could in my opinion be treated by surgery is a venous shunt; a deformity in the venous network leaving the corpus cavernosum and traveling through the tunica albuginea. This I feel is the only cause of venous leak or CVOD that could be solved by this type surgery. The issue that I see with this in the past is seeing this correctly with imaging methods, being able to clearly identify the problem. If there are other co-existing causes of CVOD present or a number of these deformities which are difficult to see, the surgery will most likely fail.
Previously, vein ligation surgery in the penis has just tried to reduce the outflow of blood from the penis by removing some of the veins on the outside of the tunica albuginea, without fully knowing what is actually causing the venous leak. This has had a high failure rate as over time the veins that are left most probably compensate and the main issue of the failure of the seal at the point of the tunica albuginea has not been addressed.
So, if this 3d angiography is capable of seeing a deformity in the venous network leaving the critical area mentioned above, and the surgeon was experienced and clever enough, the surgery may have a chance of being successful. The problem I see is that some of these veins, such as the emissary veins leaving through the tunica are so fine that any issue with these could be very difficult to detect, and it could be quite possible if there was an issue with one, there could be issues with a number of them, or it could be an issue with tunica albuginea itself, not being able to compress the subtunical venous plexus sufficiently and or a series of the emissary veins.
I would ask the doctor if he can show you the exact issue with regard to the 3d angiography? Where the deformity is and why it is causing the failure. Get him to explain it to you so you understand it fully. Write it down so you don’t forget, as you will.

The one thing you have on your side is your age. Some of the things that may cause CVOD are much more likely to be the result of aging and or lifestyle. Hence why having such surgery as an older person would be more prone to failure as there would most likely be a number of issues contributing to venous leakage, such as endothelial damage, smooth muscle loss and fibrosis.

This doctor has been mentioned a number of times on the forum:
https://doctorpaduch.com/venous-leak-mra/

He uses a technique called dynamic magnetic resonance angiography. Is this the same as the 3d angiography that your doctor is using?

Does your doctor have any patients who have had the surgery and are willing to talk to you about their experience? How well the treatment has held up over a given period of time? The age of these patients?
Always remember the doctor is working for you, not the other way around. Don’t be afraid to ask all the questions you want to, as you are paying them to answer those questions and prove they are capable of doing what they say they can do. This is even more important given that he is performing a type of surgery that in not mainstream and generally not considered viable by most specialists.
Please keep us informed as I think everyone would be interested to hear what you find out!

Hello Simbarn, first of all, thanks for your explanations.

Regarding to the diagnosis technique, if I am not wrong, I think it is the same one which is shownn in this topic (viewtopic.php?f=19&t=14575). I canción show you his explanations about venous leak, but they are in spanish (https://www.andromedi.com/medicina-sexual/fuga-venosa/). He claims, in a simple way, that if they detect that the damaged veins are not many, they try to treat you, if not, they directly supuesto you the implant.

With regards to other patients: no, I have never heard from anyone treated by him. He has in his website, which I have just shown, one supposed declaration from a patient previously treated and which was supposed to be successfulsuccessful one years after the operation. I dont know if this Is true or not, but if it is, one or two more years of good sexual function is something I would really pay for, even if after that I come back to the same situation. Other patients treated by them claim in other websites that it was all great, so I think that a reputated and probably well paid surgeon (he has been in some A urologist positions in Spain) would not risk all his reputation if this could not really work.

And, of course, I am compromisos to inform here if I decide to get the treatment and I will tell about the results.

Sorry if there are some mistakes, I am writing from my mobile with a Spanish corrector which mames this crazy

[Juerhareb]

https://juniperpublishers.com/jojun/JOJ ... 555613.php

This Is an an example of a similar intervention (not ligation but embolization, that I believe in the practice Is the same, maybe less invasive) which had at least temporary success. If this Is not a lie, it might bé a great option.