Number №1, 2019 - page 90-94

Embolization of the veins of the prostatic plexus in the treatment of venous erectile dysfunction (clinical cases)

Kapto A.A., Koledinskiy A.G.
Information about authors:
  • Kapto A.А. – PhD, Associate Professor, Department of Urology with courses of Oncology, Radiology and Andrology, Faculty of Continuing Medical Education of Russian University Of Peoples Friedship, Head of the Center of Andrology holding "SM-Clinic", Moscow; e-mail: alexander_kapto@mail.ru; https://orcid.org/0000-0002-2099-6621
  • Koledinsky A.G. – Dr.Sc., Professor, Head of the Department of Cardiology, X-ray Endovascular and Hybrid Diagnostic and Treatment Methods of Russian University Of Peoples Friedship; e-mail: koledant@mail.ru

In the structure of reason of erectile dysfunction venous insufficiency of the penis is prevails. These patients are most often offered for prosthesis of penis. X-ray surgical embolization of the veins of the prostatic plexus began to be used since 1984. According to the literature, it is effective on average in 85% of cases. The operation is performed antegradely through incision or puncture of the dorsal vein of the penis or retrograde through transfemoral X-ray surgical access. In 2018 A.A. Kapto et al. for the first time performed retrograde X-ray surgical embolization of the veins of the prostatic plexus from the transbasilar access. The cause of venous insufficiency of the penis is most often due to the varicose disease of the veins of the pelvic organs because of arteriovenous conflicts (nutcracker phenomenon, posterior nutcracker phenomenon, May-Thurner syndrome). A new direction is the implementation of combined operations, allowing to influence both the causes of venous plethora of the pelvic organs, and pathological venous drainage. In 2018 A.A. Kapto et al. performed the first operations: 1) X-ray endovascular occlusion of the veins of the prostatic plexus in combination with X-ray endovascular angioplasty and stenting of the left common iliac vein; 2) retrograde transfemoral X-ray surgical embolization of the veins of the prostatic plexus in combination with angioplasty and stenting of the left common iliac vein; 3) embolization of the left testicular vein, retrograde transfemoral X-ray surgical embolization of the veins of the prostatic plexus in combination with angioplasty and stenting of the left common iliac vein; 4) retrograde x-ray surgical embolization of the veins of the prostatic plexus from the transbasilar access in combination with angioplasty and stenting of the left common iliac vein. The use of new high-tech X-ray surgical techniques allows us to solve the problem of venogenic erectile dysfunction without performing endofalloprothesis.

Authors declare lack of the possible conflicts of interests.

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venogenic erectile dysfunction, pathological venous drainage, embolization of the veins of the prostatic plexus

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