Cavernoscanner: Technique and modelling in erectile dysfunction due to caverno-venous leakage (CVL)

Abstract

As a result of technical progress in the exploration of erectile dysfunction by caverno-venous leaks, initiated by conventional radiography under artificial erection, authenticated by ultrasound under pharmacological stimulation, cavernoscanner is proving to be an indispensable tool for their precise localization. The study of 337 consecutive examinations carried out over 5 years (2015-2020) with the Vizua platform made it possible to confirm the initial classification proposed by Virag and Paul, distinguishing between no leakage (A), deep leakage (B), superficial leakage (C), and the addition of deep and superficial leakage (D); and to identify two additional locations: opacification of the corpus spongiosum and leakage from the bottom of the corpora cavernosa. A total of 11.57% had no leakage, giving an efficiency of 88.3% for the orientation by pharmacologically stimulated ultrasound; 20.17% had a deep leakage, of which 10.9% were isolated; 15.3% had a superficial leakage, of which 5.4% were isolated; finally 46% had mixed leakage, of which 20.47% had no communication with the corpus spongiosum and leakage through the floor of the corpora cavernosa. CT scan was performed under pharmacological stimulation and contrast medium perfusion with 3 acquisition passages: filling, state phase and emptying. The study of the native and reconstructed images allows the systematized localizations, the evaluation of the severity of the leakage based on the rigidity obtained and the speed of evacuation with or without bladder opacification. Complications are minor (ecchymosis) and the very rare persistence of a rigid erection (n=3) well controlled by injection of the alpha-blocker etilefrine.