Cavernosometry

Cavernosometry is clinically indicated for the diagnostic evaluation of erectile dysfunction, particularly when venous leakage (veno-occlusive dysfunction, VED) is suspected as the underlying cause, especially in patients who do not respond to first-line ED treatments.¹ It is often considered a second-line or third-line diagnostic tool after non-invasive assessments like Color Doppler Duplex Ultrasonography (CDDU) if results are inconclusive or if a more precise quantification of venous leakage is needed.¹

Relevant Medical Conditions: The primary condition investigated using cavernosometry is Erectile Dysfunction (ED), specifically to diagnose and classify Venous Erectile Dysfunction (VED) or veno-occlusive dysfunction.¹ Patient Selection Criteria: Men with ED who have an inadequate response to oral medications or other less invasive treatments.¹ Patients in whom CDDU findings are equivocal or suggest venous leakage.¹ Younger men with primary ED where a specific vascular abnormality is suspected.¹ Candidates for surgical treatments for VED, where precise diagnosis is crucial for treatment planning.¹ The study by Gao et al. included ED patients aged 19-48 years who had persistent inability to achieve or maintain an erection, abnormal RigiScan tests, and specific CDDU findings (PSV >25 cm/s and EDV >5.0 cm/s).¹ Associated Procedures/Process: The DICC procedure, as described by Gao et al.¹, involves: Patient in supine position, nerve block anesthesia at the base of the penis. Injection of a vasoactive agent (e.g., 10 mcg alprostadil) to induce erection. Insertion of needles into the corpora cavernosa: one for saline/contrast infusion connected to an infusion pump, and another for pressure monitoring connected to a pressure transducer. First stage: Measurement of baseline intracavernous pressure (ICP) in a flaccid state, followed by infusion of saline (e.g., 60 mL normal saline + 20 mL ioversol at 0.4 mL/s) to observe initial erection and take baseline images if cavernosography is performed. Second stage: Infusion of saline (often mixed with contrast for cavernosography, e.g., 200 mL ioversol and normal saline at 1:4 ratio) at increasing speeds (e.g., 2.5, 3.5, 4.5, 4.9 mL/s) until full erection (e.g., ICP 150 mmHg) or patient discomfort. The infusion speed is then reduced to find the flow-to-maintain (FTM) the erection (e.g., ICP controlled within 150 ± 20 mmHg). If ICP decreases, the pressure decay rate is recorded. Digital images are taken if cavernosography is part of the DICC. Expected Outcomes: The outcome of cavernosometry is a detailed assessment of penile venous function. It helps to: Confirm or exclude VED as a cause of ED.¹ Quantify the severity of venous leakage (e.g., classifying VED into mild, moderate, or severe based on FTM and pressure decay values).¹ Guide individualized treatment decisions. For example, patients with mild to moderate VED might be candidates for interventional embolism, while those with severe VED might require penile prosthesis implantation if other treatments fail.¹