📖 Vascular erectile dysfunction
Erectile dysfunction (ED) affects 50% of men over 50. In up to 80% of cases, an organic cause — often vascular — underlies the problem. Two main vascular mechanisms are recognised: insufficient arterial inflow (arteriogenic) and excessive venous drainage (venous leak or venoocclusive dysfunction).
At Cochin AP-HP, we specialise in the diagnosis and treatment of venous leak erectile dysfunction, confirmed by cavernosography (dynamic CT after intracavernosal injection), and treated by percutaneous embolization of the abnormal draining veins — without surgery.
🔧 Diagnostic workup
🔬 Penile duplex Doppler
First-line investigation. After intracavernosal prostaglandin E1 injection: peak systolic velocity (PSV) >35 cm/s = normal arterial flow. End-diastolic velocity (EDV) >5 cm/s or resistive index <0.75 = venous leak.
📊 Cavernosography (dynamic CT)
Gold standard for venous leak diagnosis. CT after intracavernosal injection maps the draining veins (dorsal, crural, cavernous) and guides embolization planning.
💊 Medical treatment first
PDE5 inhibitors (sildenafil, tadalafil) at maximum dose for ≥3 months before considering invasive investigation. Hormonal profile: testosterone, prolactin, LH, FSH.
🤝 Multidisciplinary approach
IR + urology/andrology coordination. Psychological assessment if mixed organic/psychogenic aetiology. IIEF-5 score before and after treatment.
🔗 Related pages
🇫🇷 French version: dysfonction-erectile-causes.html