To maintain a firm erection during sexual intercourse, blood needs to remain in the penis until ejaculation. This is achieved through the constriction of veins, called veno-occlusion, which traps blood in the penis. After climaxing or the end of sexual stimulation, the veins dilate and blood flows back into the body. If the veins don’t constrict adequately, blood leaks out of the penis too early, leading to the premature loss of erection. Erectile dysfunction (ED) is the inability to achieve and sustain a firm erection for sexual activity, affecting a significant percentage of men. Venous leakage, a common cause of ED, occurs when veins in the penis don’t constrict effectively, leading to reduced rigidity during intercourse.

How Venous Leak Causes Erectile Dysfunction

Erectile dysfunction, impacting approximately one in five men, refers to the inability to achieve or sustain a firm enough erection for sexual activity. Over 80% of erectile dysfunction cases are attributed to venous leak. This condition hinders the ability to maintain an erection despite sufficient arterial blood flow through the penis’s cavernosal arteries. The primary issue lies in the excessive outflow of blood through veins (venous leak) in the cavernosal tissue, leading to impaired erectile function during intercourse.

(https://www.urologicatlas.theclinics.com/article/S1063-5777%2802%2900029-4/fulltext)

Symptoms of Erectile Dysfunction

The primary indication of erectile dysfunction (ED) is the incapacity to uphold an erection that is sustained for effective sexual intercourse. Those with ED might encounter challenges in achieving an erection that remains rigid throughout sexual activity, causing the erection to subside. This condition can have a notable impact on sexual performance, emotional health, and overall well-being. The inability to sustain an erection throughout sexual intercourse is a characteristic manifestation of ED, often prompting individuals to seek medical intervention and treatments to address the underlying factors and reinstate normal functionality.

Risk Factors and Causes of Erectile Dysfunction

Erectile dysfunction (ED) can arise from a variety of causes and risk factors that impact the vascular and psychological aspects of sexual function. Some common underlying factors include conditions like high blood pressure, high cholesterol, diabetes, and peripheral vascular disease, which can impair blood flow to the penis and hinder the ability to achieve and maintain an erection. Excessive stress, both mental and emotional, can also contribute to ED by affecting hormone levels and overall sexual performance. Obesity, often linked with other health conditions like diabetes and cardiovascular problems, can further compound the risk of developing ED. Family history of atherosclerosis, a condition characterized by the narrowing and hardening of arteries, can increase the susceptibility to ED. Smoking, a well-known risk factor for cardiovascular diseases, also significantly heightens the risk of ED by damaging blood vessels and impairing circulation. Additionally, anxiety, whether related to performance or other aspects, can play a role in inhibiting sexual arousal and contributing to erectile difficulties. Collectively, these factors highlight the complex interplay between physical and psychological factors that can lead to erectile dysfunction. A subset of patients develop ED due to venous leak, which is the inability to maintain an erection due to excessive outflow of blood through veins in the cavernosal tissue. The cause of venous leak is poorly understood, but it commonly affects patients of a younger age group (as young as 20 years old), and as such, is believed to be related to genetics.

Diagnosing Venous Leak on Erectile Dysfunction

Two diagnostic procedures employed to assess the presence and impact of venous leak on erectile dysfunction are Doppler ultrasound and cavernosography. Doppler ultrasound is utilized to meticulously examine the blood flow into and out of the penis. By employing sound waves, this non-invasive procedure provides insights into the velocity and direction of blood flow, aiding in the identification of abnormalities such as inadequate blood retention due to venous leak. On the other hand, cavernosography involves visualizing venous leakage through the use of radiographic contrast. This procedure provides a direct view of the veins draining the penis, and enabling the detection of any abnormalities or excessive outflow that might contribute to the erectile dysfunction. These diagnostic tools collectively play a crucial role in determining the presence of venous leak and its impact on erectile function, facilitating accurate treatment strategies for affected individuals.

(https://www.jvir.org/article/S1051-0443%2814%2900046-3/pdf)

Overview of Venous Leak Treatment

The treatment approach for this condition involves a procedure known as endovascular embolisation, specifically retrograde or anterograde embolisation. This technique targets the periprostatic venous plexus, which is achieved by inserting a slender catheter into either the deep dorsal vein of the penis or the femoral vein. To ensure precision, X-ray fluoroscopy is employed to guide the catheter’s positioning towards the targeted vein. During the procedure, small titanium coils and embolic agents are introduced via the catheter to effectively seal off the affected vein or veins. This permanent sealing prevents the problematic blood flow, addressing the underlying issue causing the condition. This method of endovascular embolisation offers a minimally invasive yet effective solution for managing the venous leakage contributing to erectile dysfunction.

(https://www.vasculardoctorindia.com/blog/will-the-coils-move-towards-my-heart-and-i-will-die-during-or-after-varicocele-embolization/)

Choosing Endovascular Embolisation for Venous Leak

The benefits of endovascular embolisation are significant, offering patients a more favorable experience and outcome. With endovascular embolisation, patients can expect:

1. Minimally Invasive Approach – Endovascular embolisation is a minimally invasive procedure performed under light sedation. This means that patients do not require general anesthesia and experience less trauma to the body compared to open surgery.
2. Same-Day Discharge – Patients typically are discharged on the same day from Vascular & Interventional Centre where the procedure is performed. This minimizes the need for an extended hospital stay, allowing patients to recover in the comfort of their own homes.
3. Minimal Pain and Discomfort – The minimally invasive nature of the procedure translates to reduced postoperative pain and discomfort compared to traditional open surgery. This leads to a more comfortable recovery process.
4. No Surgical Scars – Endovascular embolisation involves the insertion of a catheter through a small incision, resulting in no large surgical scars. This aesthetic advantage is particularly appealing to patients who prefer to avoid visible scars.
5. Quick Return to Daily Activities – Due to the nature of the procedure, patients generally experience a quicker recovery period and are able to resume their daily activities sooner than they would after open surgery.

Endovascular embolisation offers patients a range of benefits, making it an appealing option for individuals seeking effective and efficient treatment for conditions such as venous leakage contributing to erectile dysfunction.

Preparing for Venous Leak Treatment

It is crucial to have a consultation with your doctor if you have been diagnosed with venous leak. They will provide you with comprehensive details regarding the operation, its advantages, and any possible hazards. Prior to the treatment, you will be asked to disclose your medical history, including any allergies, prescription drugs, and previous surgeries. Your medical team will advise you on any pre-procedure steps that may be required, such as fasting for a specific amount of time before the surgery. You must adhere to the precise instructions given by your medical team on the day of the surgery, which may include being on time and dressing appropriately. It’s also important to prepare for the procedure psychologically and emotionally; talking to your doctor about any worries or inquiries you have will assist to reduce any stress.

Long-term Benefits of Venous Leak Treatment

Embolisation stands as a transformative treatment for venous leak, offering enduring advantages that reverberate in patients’ lives. By sealing off problematic veins with specialized agents, embolisation creates a sustained remedy for erectile challenges, fostering lasting improvements in intimacy and overall well-being. The procedure’s minimally invasive nature brings forth a shorter recovery time, minimal discomfort, and an absence of surgical scars, equipping individuals with both physical and emotional relief. Moreover, the reduction in risks associated with invasive surgery underscores embolisation’s safety and efficacy. This innovative approach not only addresses the immediate issue but also nurtures a renewed sense of confidence, bolstering relationships and enriching the tapestry of life with vitality and gratification.

FAQs:

References:

1. https://www.webmd.com/erectile-dysfunction/vascular-disease-ed
2. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776

Dr Chen Min Qi profile

Dr. Chen Min Qi is a fellowship-trained Vascular and Endovascular Surgeon who graduated from the National University of Singapore in 2005. He subsequently completed his basic and advanced training in General and Vascular Surgery while obtaining the Member of Royal College of Surgeons of Edinburgh (MRCSed) qualification in 2010, and the Master of Medicine (General Surgery) qualification in 2015. Dr Chen was subsequently successful at the fellowship exams obtaining the Fellow of Royal College of Surgeons of Edinburgh (FRCSed) qualification in 2016.

Upon completion of his advanced surgical training, Dr Chen Min Qi joined the newly opened Ng Teng Fong General Hospital (NTFGH) as a specialist in the Vascular Surgery division. In 2018, Dr Chen was awarded the Health Manpower Development Plan (HMDP) grant from MOH to undergo further subspeciality Vascular training at the internationally renowned St Mary’s Hospital in London, United Kingdom. There Dr Chen gained further experience in surgeries on complex abdominal and thoracoabdominal aortic aneurysms, redo open repair of abdominal aortic aneurysms following failed EVAR surgeries as well as carotid endarterectomy surgery and lower limb revascularization surgeries.

Upon his return in 2020, Dr Chen Min Qi joined the newly formed Woodlands Health as head of their Vascular service, before joining his current practice at the Vascular and Interventional Centre in January 2023.