Anyone heard of endovascular repair for venous leak?

[jwpenn82]

I’m sure it may of been already discussed but I’m curious if anyone has had this done and what was the outcome?

[wolfpacker]

I haven't seen any of the vascular surgeries to be successful on this forum. Maybe all the success story guys are hiding out elsewhere, but my guess is that the vascular surgeries just don't work well to treat ED.

[Gt1956]

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.

[jwpenn82]

Thanks for the replies. I posted a video on here a while back where a interventional radiologist is doing venous leak interventions. Of course I couldn’t resist and reached out to him. Today I had a video consult and what he says makes sense. Struggling with ED for 4 years of course I’m hopeful of new treatments ect. However this doctor was upfront he basically said with his interventions all we could do is try or not it was up to me. He said prior surgeries had low improvement scores but his is minimally invasive and guided by ct capersonography he is able to pin point the location of the leak and attempt to repair it. He said realistically he could say around 60 percent success personally. He also added successful treatment might only be going back to oral meds from my current trimix.

What do you guys think?

[Txagq8]

I can tell you what they told me at the University of Kansas Medical School, although it’s been 20+ years.

I was at Command &General Staff College at Leavenworth, and was able to wrangle a civilian consult for a full ED workup with them. This was about 10 yrs after I was formally diagnosed and had started injections and about 3 years after Viagra hit the pharmacies.

The doctor who I had my exit consultation with basically said that surgery to fix leaking veins sounded good in theory but the problem was the body is very good at trying to repair itself. So, he said, he could go in.....cut veins, tie things off, plug up the places that allowed the veins to turn loose of blood as fast as the arteries were pumping it in.

Once I healed up I would probably see a short term improvement in erection capability, but that it wouldn’t be long before the body had discovered different blood vessels and pathways for blood flow to get right back to allowing leakage to occur.

It’s hard to remember everything that he said, I was disappointed that they couldn’t knock me out, cut me open, and fix everything and make life pleasant and convenient. He did say that implants were good, and getting better, and that in 20 years I would have one. He might have been off by a week or two.

For me, the fix the venous leak thing fell into the “if it sounds too good to be true, it probably is” category. I never once regretted that consult, though, as I could carry my medical records to any family practice doc anywhere as the Army moved me around and get them to renew his prescriptions over and over again.

[jwpenn82]

Can I also add that his office will work with my insurance and if denied will send appeals and documentation in so it’s covered. This doesn’t seem like a sham or scam treatment. Either way it will end up costing me airfare, hotel cost, and my insurance plan is 80/20 so 20 percent will come out of my pocket.

[jwpenn82]

Here is the original link of the doctor that I found that lead me to contact him. It’s a YouTube video but done pretty well. He did make sure to tell me orginally with the video he believed success rates would be above 80 percent. That he used the very few studies that have been done with this to come to that number. Now he believes it’s closer to 60 percent. He was very honest during my video consult and wasn’t trying to sell anything.

He gave me the break down of how this transpired. Basically he is known and specializes in prostate artery embolization. Throughout his years of completing this he recognized the great need for an erectile dysfunction intervention. He then started reviewing some studies and only launched this procedure this year. He made that video as a project for a meeting to launch the venous intervention and has gotten a huge response from people with erectile dysfunction around the world.

I know everyone says that venous leak surgery has a very poor response rate. However interventional radiology doing this sort of treatment I believe is rather new and there aren’t many places I could find that do this. Below is the link if anyone cares to watch.

https://m.youtube.com/watch?v=A669kqqNT ... =TheIRtist

[phallus]

Go for it and report back to us. If this was in the EU, and i knew for sure i had VL, i would undergo it myself in a heartbeat.

We're in a grave need of something treating VL. Getting an implant when you have VL is a bit like fishing with dynamit,you're destroying healthy tissue just to bypass one smaller structual issue in the penis, it's a overkill, but unfortunately a necessity when everything else have been tried without success.

Issam kably seems to genuinely believe in his method. As older studies have shown in regards to VL, finding the exact point of leak is crucial for good outcomes, which may explain why embolization surgery have failed so many times before.

Worst case scenario it doesn't work, but then you know you tried everything before moving on to an implant. On the other hand, if it does work, it would help some people restoring their erection without an implant.

[jwpenn82]

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.

[Simbarn]

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.