Cavernosography is a radiopaque method of examining the veins and arteries of the penis in an erection state. The results of the procedure are in demand in the differential diagnosis of various types of erectile dysfunction, as well as in determining the localization of plaques, foci of atrophy and sclerosis in cavernous bodies against the background of Peyronie’s disease. A vasoactive drug and a contrast agent are injected into the penis. The images are taken in several projections at certain intervals.
Indications
Indications for cavernosography are erectile dysfunction of an organic nature with pathological venous discharge, as well as structural changes in cavernous bodies with the presence of areas of atrophy, sclerosis or fibrous degeneration in Peyronie’s disease. In addition, cavernosography is prescribed to determine the proportions of the legs and the trunk of the penis when deciding on surgical intervention (corrugation of the legs) in patients suffering from erectile dysfunction of mixed genesis. The technique is used not only to diagnose and determine the tactics of treatment of organic erectile dysfunction, but also to assess the severity of damage to the penis during injuries.
Contraindications
Contraindications to cavernosography are allergy to iodine preparations, the presence of inflammation in the organs of the genitourinary system or cavernous bodies, severe bronchial asthma and hyperazotemia (with a serum creatinine level of more than 130 microns / l). The study is not carried out with urethrocavernous fistula, diseases and pathological conditions in which blood clotting disorders are observed. To detect allergies to iodine-containing contrast agents, a test sample can be used, during which 1 ml of the drug is administered to the patient (10-20% of the total dose used during the study).
Preparation
Special preparation is not required, going to the procedure, it is enough to carefully carry out the usual hygiene measures. It is necessary to bring all available medical documentation to the cavernosography: test results, data from other diagnostic techniques, conclusions of consulting doctors, extracts from medical histories, etc. The patient is laid on a couch. A contrast agent (omnipack, ultravist, urographin) in a volume of 10-20 ml is injected into the cavernous bodies using a thin needle.
Sometimes a drug is also injected into the penis to stimulate an erection. Such an injection can be part of a cavernosography or carried out as part of a separate study (intracavernous test), which allows to assess the severity and time of the onset of an erection. The introduction of the drug is sometimes combined with manual stimulation, watching an erotic magazine or a video.
Methodology of conducting
After the administration of the drugs, a series of pictures are taken in various projections. After a while, the pictures are repeated. The standard sequence of time for performing radiographs during cavernosography: at 1 minute, at 3 minutes (side shot), at 10, 15 and 25 minutes. After completion of the study, a sterile bandage is applied to the penis. The patient is transported to the ward, advised to observe bed rest for 2 hours, and then released home. The radiologist examines the images and draws up a conclusion. As a rule, the document is issued the day after the study.
Interpretation of results
The study makes it possible to determine the cause of erectile dysfunction in the defeat of the veins and cavernous bodies of the penis. When processing the results of cavernosography, pathological venous drainage, the presence of pathological shunts between the cavernous bodies and the spongy body may be detected. In addition, cavernosography makes it possible to identify areas of sclerosis and atrophy in cavernous bodies caused by previous diseases and injuries, fibrous changes in the protein membrane of cavernous bodies in Peyronie’s disease and congenital disorders of the structure of cavernous bodies or the venous network of the penis. Traumatic injuries of the penis are indicated by the presence of contrast congestion in the area of damage to blood vessels and cavernous bodies.
Absence of violations during cavernosography on the arterial nature of organic erectile dysfunction. The exclusion of psychogenic erectile dysfunction is usually not required, since it is carried out at the previous stage of differential diagnosis. In erectile dysfunction of mixed genesis, cavernosography data are compared with the results of other diagnostic procedures (penile ultrasound, intracavernous test, etc.), which allows us to get a complete picture of the influence of various pathogenetic mechanisms on the disorder of the patient’s erectile function.
