Dr. Darius Paduch

[johnsond1415]

I have had venous leak my entire life and have an appointment coming up with Dr. Paduch. Was wondering if anyone has any experience with him? He seems to be well respected but he posts a lot of tweets claiming widespread success with various surgeries/procedures such as venous ligation, shockwave therapy, he is experimenting with medical marijuana, etc. All of this marketing and self-promotion has me a bit concerned so was hoping someone would be able to chime in. Thanks!

[60s_surfer]

I have no experience with Dr. Paduch. However, there are a number of posts on Franktalk discussing venous ligation. My recollection is that most of them are negative, some extremely so. Using the search function could provide you with more information.

[tomas1]

To each his own, but I hate self promoters.

[Larry10625]

I have no experience with Dr. Paduch. However, there are a number of posts on Franktalk discussing venous ligation. My recollection is that most of them are negative, some extremely so. Using the search function could provide you with more information.

My surgeon and Dr. Perito both answered me while I was on vacation and BOTH are very strongly against venous ligation surgery. They say it is old school thinking that just simply doesn't work. RUN the other way

Larry

[ED2013]

I heavily researched the subject of these surgeries. My conclusion was that they are experimental. I have never heard of anyone having one of these surgeries and it curing their ED for the rest of their life

[passerarf]

My understanding is that they're using a new 3D MRA method (Dynamic Magnetic Resonance Angiography) that can more precisely pinpoint specifically where vascular issues exist in the penis. And the idea is, based on that, they're able to do more precise vein ligation if venous leak is indeed the issue.

Does anyone have any thoughts or additional information on this?

Weill Cornell also seems to be involved and here's a link: https://www.ncbi.nlm.nih.gov/pubmed/31784778

[68CatFan]

I've had shockwave therapy at two different clinics. Saw no improvement at all. I believe it's a sham. So is stem cell therapy. Both treatments are based off of flawed studies. Still, like a lot of men I ran in with high hopes.

[passerarf]

Yeah, I've tried Shockwave too and didn't see improvement.

But what I'm referring to here with Dr. Paduch, however, is what he's calling a more exact and precise method to treat venous leak with ligation surgery. Ligation surgery has a checkered past of providing some sort of improvement for the first 6 months or so, but then reverting to pre-surgery levels of venous leak within a year. Dr. Paduch claims that his 3D Dynamic MRA is able to pinpoint which veins specifically should be ligated, leading to a higher success rate that sustains for longer (but it seems like there isn't much data yet to substantiate this claim).

Anyway, I thought it was interesting that the 3D Dynamic MRA is able to more precisely pinpoint vascular irregularities and figured I'd see if anyone else has thoughts on this.

[Simbarn]

Yeah, I've tried Shockwave too and didn't see improvement.

But what I'm referring to here with Dr. Paduch, however, is what he's calling a more exact and precise method to treat venous leak with ligation surgery. Ligation surgery has a checkered past of providing some sort of improvement for the first 6 months or so, but then reverting to pre-surgery levels of venous leak within a year. Dr. Paduch claims that his 3D Dynamic MRA is able to pinpoint which veins specifically should be ligated, leading to a higher success rate that sustains for longer (but it seems like there isn't much data yet to substantiate this claim).

Anyway, I thought it was interesting that the 3D Dynamic MRA is able to more precisely pinpoint vascular irregularities and figured I'd see if anyone else has thoughts on this.

Hi Passerarf, I have given venous leakage a great deal of thought, and found a number of interesting studies that shed a new light on why it happens.
Read my post here to save repeating it all.
viewtopic.php?f=3&t=14596#p128888

I feel the surgeon would have to remove the offending veins that are either directly under the tunica albuginea or the faulty emissary veins that pass through the tunica for this approach to be really viable. These are the veins that get compressed, which severely limits outflow. The more compression of these veins by the corpus cavernosum the better the restriction. This all depends on two things:
The ability of smooth muscle in the corpus cavernosum to work effectively and its quantity, plus the structural integrity of the trabeculae.
The ability of the tunica albuginea to perform its function of creating a seal.

What happens with the veins after that point is IMO not going to fix the issue for long. Yes, it may help to lessen the “rate” of outflow, but there will still be “a leak” as there must still be a route for the blood to escape via some of these veins. Therefore if the leak is still at the critical areas as I mentioned above the blood will still escape.

As the issue with the smooth muscle or the tunica albuginea worsens and research shows it does, as each decade of life passes, the leak will continue to worsen, and the mitigated effect of the surgery will wane. This is most likely why vein ligation is not very successful or does not work for long.
As your condition looks to be congenital, (as we have spoken about this before privately) you may have some abnormal “venous shunts” that leave the corpus cavernosum feeding directly into the veins just on the outside of the tunica albuginea (TT). Essentially these could be deformed emissary veins that allow too much blood to pass through the TT. If the doctor you have mentioned, has a method by which he can very accurately find such veins and remove them, there then IMO could be a chance that such surgery could be successful. The ligation surgery I have seen in studies, does not seem to be anywhere near this accurate. If your issue is to do with a faulty congenital mechanism of the corpus cavernosum to be able to expand sufficiently, such as some form of hypertonic cavernous smooth muscle as we have discussed in detail privately, I think the surgery would not help a great deal.
It will be very interesting to see how you respond to the phentolamine mesylate tablets.

[passerarf]

Thanks for chiming in Simbarn and for all your help/insight!

This is a video that explains how they do this procedure in detail: https://doctorpaduch.com/venous-leak-mra/ - I wonder if watching that will help you understand whether it fits the framework that you've laid out here?