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Also known as
Cavernosometry, Corpus Cavernosography, Penile Cavernosography, Dynamic Infusion Cavernosography (DIC)
Definition
Cavernosography is a diagnostic imaging procedure used primarily to evaluate erectile dysfunction (ED), particularly when veno-occlusive dysfunction (VOD) or venous leakage is suspected as the underlying cause.1 It involves the injection of a radiopaque contrast medium directly into the corpora cavernosa, the erectile tissues of the penis. Following the injection, X-ray images (fluoroscopy) or Computed Tomography (CT) scans are taken, often while an erection is pharmacologically induced, to visualize the penile venous drainage system.2 The purpose of cavernosography is to identify the site and extent of any abnormal venous leakage from the corpora cavernosa, which can prevent the achievement or maintenance of a rigid erection.2 It can also help detect structural abnormalities within the corpora cavernosa. While conventional cavernosography uses fluoroscopy, CT cavernosography is a more recent advancement that provides detailed cross-sectional images, offering potential advantages in terms of site-specific leak identification, reduced radiation exposure, and less contrast material usage.2
Clinical Context
Cavernosography is typically considered in the diagnostic workup of patients with erectile dysfunction (ED) who have not responded to first-line therapies, such as oral medications (e.g., PDE5 inhibitors), and where a vascular etiology, specifically veno-occlusive dysfunction (VOD), is suspected.1 It is particularly useful in identifying the presence, location, and severity of venous leaks from the corpora cavernosa, which can impair the ability to maintain an erection.2
Patient selection criteria often include men with a history suggestive of VOD, such as those who can achieve but not maintain an erection, or those with an abnormal penile Doppler ultrasound showing increased end-diastolic velocity. It may also be considered in younger patients with primary ED to rule out congenital venous anomalies, or in patients with Peyronie’s disease to assess corporal integrity prior to surgical intervention. The procedure helps to confirm or reject organic ED due to pathological cavernosal venous drainage, thereby guiding the physician in choosing appropriate therapeutic interventions, which might include surgical ligation of leaking veins or endovascular embolization.1
While conventional cavernosography has been a standard, CT cavernosography is emerging as a more detailed imaging method, potentially offering better anatomical visualization and treatment planning.2 Expected outcomes from the procedure are primarily diagnostic, providing crucial information about the penile venous anatomy and function to plan further management. It is not a therapeutic procedure itself, but it is critical for selecting patients who may benefit from venous leak surgery or other targeted treatments.1