CT Cavernosography: A New Method for Evaluating Venous Incompetence in Impotent Patients

Background/Objective: Cavernosography is traditionally recognized as an imaging modality for evaluation of venous leakage in impotent men. We introduce CT cavernosography as a novel method for demonstrating leaking veins. Patients and Methods: Sixty-seven patients diagnosed as venous incompetence by Doppler study, and eight normal subjects were enrolled into the study. After intracavernosal injection of papaverine, normal saline was injected into the corpora cavernosa and the injection rate was gradually increased and the penis was observed to obtain the injection rate causing erection. Then contrast media was injected into the corpus cavernosum with obtained injection rate followed by CT scan of the penis and pelvis. Results: In the first group, 63 patients (94%) had venous leakage by CT cavernosography. In this group, full erection was observed at the rate of 36 ml/min of saline injection in three patients and 24 ml/min in one patient. In 46 patients (73%), erection was induced with saline injection at the rates of 48-120 ml/min, and in 17 patients (27%) no full erection was demonstrated even at the injection rate of 120 ml/min. In the 2nd group we observed full erection after saline injection at the rates of 36 ml/min and 24 ml/min in five and three patients, respectively. Conclusion: Beside the capability of CT source images in precise visualization of all leaking veins without superimposition of bony structures, different techniques of two- or three- dimensional reformation enable us to demonstrate the anatomy of the penis and the leaking veins elegantly for further surgical planning.