Novel, Evidence-based, Classification of Cavernous Venous Occlusive Disease (CVOD). - Beyond the Abstract

My practice in men's sexual health is largely based on referrals from other Urologists, so it is often a challenge to provide patients with additional insights. In the post Viagra era the men I see fall largely into the classification of PDE5 Inh failures.

When you drill down the data that means a significant number are cancer survivors or have very significant risk factors for cardiovascular disease like insulin dependent diabetics and men who have had angioplasty or cardiac bypass for symptomatic CVD.

For this particular study I was interested in better understanding men who have isolated cavernous venous occlusive disease. We know that PDE 5 Inh drugs work to enhance cavernous arterial inflows. The pathology of CVOD is totally different, especially in men who we characterize as 'lifelong ED'. That means men who have reported difficulty sustaining erections since initiation of their sexual lives.

With an evidence based study like the Duplex Color Doppler examination patients can be categorized as Purely Arterial Insufficiency, Mixed Arterial and Venous Insufficiency and Purely Venous Insufficiency. It was this group of purely venous insufficiency I wanted to look at. The literature tells us very little about this pathophysiology compared to arterial insufficiency and almost nothing is written about categorizing degree or severity without highly invasive testing. My resident diligently reviewed cases to come up with these pure venous leakers. We were then able to statistically correlate SHIM score severity and therapeutic outcomes like satisfaction with penile injections or progression to penile implant placement with Doppler parameters. I hope these categorization of mild - moderate - severe will be useful to other Urology specialists struggling to identify and treat men with CVOD.

 

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Written By: Gregory A Broderick, MD

Department of Urology, Mayo Clinic, Jacksonville, FL., Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL., Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL., Department of Urology, Mayo Clinic, Jacksonville, FL.