Sealing the Leak: Percutaneous Deep Dorsal Penile Vein Embolization Using Glubran for Veno-Occlusive Erectile Dysfunction - A Case Report
This case report describes the first instance in the Arab region of successfully treating medically refractory veno-occlusive erectile dysfunction in a 67-year-old man using percutaneous deep dorsal penile vein embolization with a Glubran and lipiodol mixture, demonstrating the feasibility of this minimally invasive approach following a structured diagnostic workup.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For many men, the ability to achieve and maintain an erection is a matter of complex plumbing working in perfect harmony. When a man becomes sexually aroused, nerves signal the arteries in the penis to open wide, allowing a rush of blood to fill two sponge-like chambers inside. As these chambers swell, they press against a tough outer sheath, which naturally squeezes shut the tiny veins that usually drain blood away. This mechanism traps the blood inside, creating the rigidity needed for intercourse. When this system fails, the condition is known as erectile dysfunction. While many factors can cause this, one specific mechanical failure occurs when the veins do not close properly. Instead of trapping the blood, they leak it out too quickly, preventing the erection from becoming firm or lasting long enough. This is called veno-occlusive dysfunction, a problem that often resists standard medications and leaves patients without clear solutions.
A team of doctors in Lebanon recently documented a successful attempt to fix this specific type of leak using a minimally invasive procedure. They treated a 67-year-old man who had struggled with erectile dysfunction for a year and a half. Despite taking sildenafil, a common medication that helps relax blood vessels, his condition did not improve. His medical history included high blood pressure and a long history of smoking, both of which can damage blood vessels over time. To understand exactly what was wrong, the medical team first used a specialized ultrasound scan. They injected a medication directly into the penis to stimulate blood flow and measured the speed of the blood. The scan showed that blood was flowing in quickly and strongly, proving the arteries were working fine. However, the blood was also flowing out just as fast, with a speed of 23 centimeters per second at the end of the heartbeat cycle, a sign that the veins were failing to close. Because the patient could not achieve a fully rigid state during the scan, the doctors needed a more definitive test. They performed a procedure called cavernosography, where they injected a contrast dye into the penis and watched it move through the veins using X-ray imaging. This confirmed the diagnosis: the dye rushed out of the penis and into the deep pelvic veins almost immediately, proving that a significant leak was preventing the erection from holding.
With the problem identified, the doctors moved to a treatment that avoided open surgery. Instead of cutting into the body to tie off the leaking veins, they used a catheter, a thin flexible tube, to reach the problem area from the inside. They accessed the deep dorsal vein of the penis, a large vessel running along the top, and guided the catheter down toward the retropubic venous plexus, a network of veins located behind the pubic bone where the leak was occurring. To ensure the treatment material stayed exactly where it was needed and did not flow backward into the rest of the body, they placed a tourniquet around the base of the penis. Through the catheter, they injected a mixture of a liquid glue called cyanoacrylate and an oil-based contrast agent. This mixture hardened quickly, effectively sealing the leaky veins. The doctors then took final X-ray images to confirm that the blood flow had been successfully blocked at the source.
The results of this intervention were measured three months later. A follow-up ultrasound showed that the speed at which blood was leaking out of the penis had dropped significantly, falling from 23 centimeters per second down to 8.6 centimeters per second. While a small amount of leakage remained, the improvement was substantial. When the patient received the same medication to stimulate an erection, he was able to achieve a rigid state that he had not been able to maintain before. His scores on standard questionnaires regarding sexual function improved dramatically, moving from a low of 10 to a high of 22, and his ability to maintain hardness improved as well. This case represents the first time this specific embolization technique has been reported in Lebanon and the broader Arab region. The authors note that while the procedure was technically successful and the patient's condition improved, the remaining leak suggests the fix was partial rather than complete. They emphasize that this approach offers a new, less invasive option for men who have not responded to medication, but they also caution that more long-term data is needed to understand how durable the results are over time. This single case demonstrates that sealing a venous leak from the inside is a feasible path forward for a difficult medical problem.
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