Anyone heard of endovascular repair for venous leak?

[Gt1956]

Simbarn, thanks for the detailed post. I get a bit sad to read of younger men searching for a cause of their ED thinking that if a cause is found, it can be fixed. It just don't work that way. Not yet at least. There isn't a doctor in a small country somewhere with the only cure that you can find on the internet.

[mayoung10]

Only my opinion based on a little research that I have done. Using the word "leak" leads people to think it is repairable. The mechanism to trap blood in the penis for an erection is actually an area of tissue that swells based on nitrogen oxide signals. "Leak" sounds like it should be easy to fix. But just the opposite.
Oh, the nitogen oxide compound only lasts for a few seconds or less before it breaks down. The body must continually make it to keep the erection.
You may notice that lots of urologists don't even check for venous leaks. Not much reason to test for something that has very little effective treatments.

I agree with you.

It may sound possible to fix a “leak”, as the word implies that there is a hole somewhere and liquid or a gas is escaping. In this instance it is blood we are talking about.
The term “venous leak” is used by doctors to use with patients or laymen so that they can have some understanding of what might be going wrong in their penis.
“You have a venous leak” they say. Ok, so what IS a venous leak in the penis? I think we need to have some more understanding of this to appreciate how difficult it is to fix.

The term venous leak is actually synonymous with the term CVOD, which stands for corporal veno-occlusive dysfunction. This means the penis is not able to perform or has difficulty performing the task of venous occlusion. In simple terms; not being able to trap enough blood in its erectile tissues to remain rigid. Generally doctors don’t say you have CVOD, they just say you have a venous leak to keep it simple.
To understand more about the dysfunctions with venous occlusion in the penis it helps if you understand how the penis performs this task normally. I am not going to go into all of this in detail here as those of you who are interested can go online and do some reading if you do not already understand it.
However, for the penis to have a good erection the corpus cavernosum (CC) needs to be able to expand to the point whereby it can compress the veins on the outside of these two cylinders which lie underneath the tunica albuginea (TA), whilst at the same time stretching the TA and causing the emissary veins leaving and running through the TA, to be compressed also. This causes blood flow out of the penis to be reduced dramatically to the point whereby enough pressure is created in the erectile tissues in the CC and thus the penis becomes much bigger and rigid.

Sounds simple, but it is far from simple. There are many process that need to happen correctly for this occur, that can go wrong, ultimately leading to CVOD. A venous leak (for most of us unless you have an obvious congenital deformity or a simple venous shunt) is not really one single leak or a few leaks at all. It is a combination of factors that lead to blood escaping through the many exit channels in the penis. Depending on how much the CC fails to expand, blood escapes through all the veins underneath the tunica and out through all the emissary veins. There is no way to fix all those leaks! Some surgeries have attempted to remedy this by reducing the quantity of veins that lie after these veins that transport blood out from the penis. They are literally removed. But it only yields a temporary improvement and does not fix the original issue. It’s a work around so to speak. Blood flow would in this instance be reduced when the penis is flaccid, so over time our body will try and compensate by creating more channels or the veins that have been left will most likely enlarge.

Why does CVOD occur? The truth here is it can be a long list of possible dysfunctions that we could almost just say it’s the same list that create most causes of erectile dysfunction. Here are just some of these:

Atherosclerosis; narrowing of the arteries that supply blood to penis or the cavernosal arteries themselves
Endothelial damage or dysfunction in the erectile tissues, which leads to compromised NO pathway function.
Endothelial damage or dysfunction in the cavernosal arteries or the arteries leading into these vessels.
Loss of smooth muscle in these tissues and the cavernosal arteries. Only a 15% loss is suggested as being enough to start causing CVOD.
Adipocyte (fat cells) formation underneath the tunica.
Increased sympathetic activity in the penis from aging (increased adrenergic expression or sensitivity) inhibiting smooth muscle relaxation
Change in the composition of the cells that comprise the tunica which have been suggested to lead to sealing problems underneath the tunica.
Peyronie's disease.
Strong psychogenic anxiety issues which increase adrenergic activity.
Nitric oxide dysfunctions.
Pelvic floor dysfunction; muscle spasm affecting the pudendal nerve and the arteries leading to the cavernosal arteries.
Neurological issues affecting either reflex or psychogenic erectile stimulation
Pudendal nerve entrapment
Hormone dysfunction or loss, excess of estrogen, loss of testosterone and DHT, leading to a loss of nocturnal erections and subsequent hypoxic conditions in the penis.

A number of these dysfunctions can exist together making the CVOD issue quite complex.
Ageing of course is implicated in many of the above conditions, oxidative stress being a major player. However, these can occur even before middle age from particular lifestyle choices.

All of these issues can result in the CC either not being able to expand sufficiently to put enough pressure on the veins underneath the tunica or the tunica not being able to form a good seal with regard to those veins.
These are the common reasons why the penis fails to perform venous occlusion well and therefore CVOD happens: we get a leak so to speak, but in reality its many leaks! It’s not a single venous leak!
In less common instances IMO a venous leak could be caused by a venous shunt, that is a deformity where there is a particular point of escape, but I think these are quite rare in comparison to the above. These could in theory be repaired. The issue is having the technology to be able to find and see them accurately and then being able to seal the offending vein.

The process of ageing, diabetes and lack of exercise combined with our typical high fat/sugar diets create most of the above (with some help from our genetics) and cause the conditions which enable CVOD.
There is no simple surgical cure.

Sometimes the causes that create CVOD can be fixed if caught early enough. Most of the time, doctors will treat them with the only things they know. PDE5 inhibitors to boost the function of the NO pathway, this can overcome the negative effects of some of the above mentioned dysfunctions for a period of time until they intensify. Vasoactive penis injections work even better as they bypass more of the functions that many of the dysfunctions affect until quantities of smooth muscle in the penis decline considerably or the TA fails. The penis is then at the point of not being able to be helped by medications of any sort. Once the smooth muscle has declined to that stage and non-compliant collagen tissue has formed in its place (fibrosis is clearly evident), an implant is the only way to remedy the problem. That is until science finds a way to reverse this process. IMO we can do this in the early stages but once it has taken hold and advancing age is also upon us, there is not a lot we can do.

What do you think about androgen exposure therapy to promote repair of the penis in a more systemic way?

Treating and identifying this long list of micro etiologies seems to be impractical or even impossible depending on how lazy your urologist is.

Would the best treatment be to just create the healthiest biological environment for erections and try to allow the body to do its own thing?

(aka be healthy, take pde5s, androgens/dht).

[young_leaking]

Have you had the procedure yet? If so, how did it go?

[Simbarn]

What do you think about androgen exposure therapy to promote repair of the penis in a more systemic way?

Treating and identifying this long list of micro etiologies seems to be impractical or even impossible depending on how lazy your urologist is.

Would the best treatment be to just create the healthiest biological environment for erections and try to allow the body to do its own thing?

(aka be healthy, take pde5s, androgens/dht).

I am not familiar with "androgen exposure therapy". Is this some type of short term TRT, so that the penis is exposed to higher levels of testosterone and DHT for a period of time?

I do know that low levels of T over time will cause some of those issues I discuss to start evolving. In the early stages, rectifying this low level may reverse these changes. However, if the problems are quite advanced there may be minimal improvement. Resveratrol combined with low dose PDE5i has been shown to be effective with stopping and even reversing some of the damage caused by excessive oxidative stress in the blood vessels also. A combination of treatments may be even more successful.

Yes, trying to treat such a long list of possible causes of CVOD is difficult, this is why the term venous leak is a confusing term for many as it over simplifies the issue. Its a very complex issue. One that requires more research on many topics. Such research will benefit far more than just the penis itself, as many of these etiologies affect the whole body's vascular system eventually.
The penis is just an extension of the peripheral vascular system. Its good to understand that.

[returntocenter]

Here is an update for everyone. I’ve decided to go for this if the treatment completely fails at least I will know the exact location of my venous leak. I am also opting for this because as of right now the only treatment option I have is trimix injections. I kinda feel like why wait on the sidelines and wait for failure of trimix then go for an implant. I might as well try something and if it completely fails I really had nothing to lose as stated above.

So the scheduling department reached out to me today and I have emailed them back. Right now I’m just waiting to hear on a date then I will book my flight and hotel. Sounds like this will take place in the morning and first the interventional radiologist will scan me to find the leak then determine a plane of action. After the procedure I’m released but require staying in town for 24hrs.

I will definitely post here after and let everyone know if I have any improvement.

Hey man how did the procedure go? Really curious to hear if it worked. Wishing you the best.

[jwpenn82]

Procedure is February so no news yet

[fdct2k]

I have to explain my case, and where I am now.

I suffered from a trauma to the penis 10 years ago, I never went to a doctor to look at it, but after the trauma I started having trouble getting a long and rigid erection

Last month I went to visit a vascular surgeon, he told me to do a doppler ultrasound and then an angiotac 3D, both test will be done in January in Dr. Natalio cruz clinic, in Sevilla (Spain).

He told me that the fracture in the penis could cause the rupture of the tunica albuginea, and consequently the venous leak, when we have the results of the tests, we will decide if we can opt for an embolization operation.

I will keep you informed about the process.

[densal07]

@jwpenn82 who is the founder of this surgery? Is it Hanno Hoppe and his "Percutaneous Treatment of Venous Erectile Dysfunction"?

But wishing you the best. Every time a new procedure appears it's a light for us that the medicine is getting some advance in this field - which is of course very welcomed.

[jwpenn82]

@jwpenn82 who is the founder of this surgery? Is it Hanno Hoppe and his "Percutaneous Treatment of Venous Erectile Dysfunction"?

But wishing you the best. Every time a new procedure appears it's a light for us that the medicine is getting some advance in this field - which is of course very welcomed.

I’m not sure who the founder of this procedure is. I get what everyone is saying with the previous detailed messages about venous leak. I do understand that nothing has really been proven to be a cure and an implant is the next best thing. However what am I suppose to do just sit back and do nothing. No harm in trying to fix my problem. Im not spending a bunch of money on this in fact my health insurance is covering a large portion.

[passerarf]

Hey man, any news on this? thanks again for sharing your experience