treatment for venous leak

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redbullmaster

Are soft glans a sign of a venous leak as in researching this issue I can across a treatment called sclerotherapy. Found it on the international andrology institute web site, they also do Penile artery bypass surgery and a shock wave treatment.

I've copied and pasted from there site, what sclerotherapy is.

 At London Andrology Institute we have pioneered a technique called sclerotherapy, which is the only scientifically reported technique that successfully cures venous leakage. It is a minor surgical procedure under local anesthesia , lasts 20 minutes and patients can return almost immediately to everyday activities after the operation.

In effect, a special material (Aethoxysclerol) is injected in the main vein of the penis through a small incision, which results to a shrinkage of the pelvic veins. In this way the blood outflow during erections is minimized and a rigid erection can be achieved. Two x-rays are taken before and after sclerotherapy to confirm the vein shrinkage. The advantages of this technique are summarized below:
Minimally invasive, low cost treatment for venous leak with no serious side-effects or complications
Complete cure of erectile dysfunction reported for 63% of patients and significant improvement (patients become responsive to oral drugs) reported for 14% of patients, giving an overall success rate of 77%

This is a list of there doctors, posted these to see if anyone's had any dealing with them, as they also do surgery for peyronies disease

Dr Nenad Djakovic
Dr Franklin Kuehhas
Dr Andy Zamar
Professor Miroslav Djordjevic

james1947

redbullmaster

Appreciating you for posting on our forum.
Also Dr. Kuehhas is highly regarded here.
My problems are the 63%, 77%. I strongly believe that I will fall in the remaining 23% :(
Will be also happy to get some more details regarding this surgery, as venous leak correcting surgeries to my knowledge are very complicated and have very low success rate.
Regarding shock wave treatment you are invited to read the board dedicated to it, the reports are very disappointing.

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

NeoV


james1947

I split redbullmaster post and the answer and opened a new topic as this ED treatment sounds revolutionary, it is minimum invasive, low cost, high success rate and supported by Dr. Kuehass that is much appreciated on the forum.
Hope will see additional posts of redbullmaster and maybe other members.

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

james1947

This what I found on London Andrology Institute website:

Penile Sclerotherapy
A common cause of erectile dysfunction, especially in younger men, is venous leakage, which is estimated to be present in 30 - 70% of cases. In a healthy male, blood that flows through the arteries is trapped in the erectile tissue, which in turn leads to increased pressure inside the penis and a rigid erection. In patients suffering from venous leak there are some structural deficiencies of the blood trapping mechanism, which results to blood leaking during erection to the nearby arteries and in turn soft or complete loss of erections.   Patients with venous leak will usually suffer from erectile dysfunction from a young age, which in many cases is position-dependent and often report that their penis glans are soft during erections. Our doctors can easily diagnose venous leakage through an ultrasound test.
Unfortunately, patients suffering from venous leakage respond poorly to oral drugs. A common practice has been the use of a penis ring, which is an elastic band tied around the base of the penis, after erection has been achieved, which in effect restricts the penile blood outflow. Beyond the impracticalities of using a penis ring, there are also health risks resulting from extensive use, which can lead to nerve damage and a deterioration of erectile dysfunction. Whereas surgical options for the treatment of venous leakage have been around for a long time, their outcomes have not been satisfactory.
At London Andrology Institute we have pioneered a technique called sclerotherapy, which is the only scientifically reported technique that successfully cures venous leakage. It is a minor surgical procedure under local anesthesia , lasts 20 minutes and patients can return almost immediately to everyday activities after the operation.
In effect, a special material (Aethoxysclerol) is injected in the main vein of the penis through a small incision, which results to a shrinkage of the pelvic veins. In this way the blood outflow during erections is minimized and a rigid erection can be achieved. Two x-rays are taken before and after sclerotherapy to confirm the vein shrinkage. The advantages of this technique are summarized below:
Minimally invasive, low cost treatment for venous leak with no serious side-effects or complications
Complete cure of erectile dysfunction reported for 63% of patients and significant improvement (patients become responsive to oral drugs) reported for 14% of patients, giving an overall success rate of 77%

Interesting to know how many man were treated with this treatment.
I sent them an email, asked for price and where the treatment is available outside the UK.

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

skunkworks

This is an emotionally destructive condition, we all have it, let's be nice to each other.

Review of current treatment options by Levine and Sherer]

Orome

With the discouraging results from vein ligation and other such treatment of venous leakage and relapse, how many of those were preformed men with cardiovascular or other such underlying conditions that caused the venous leak in the first place, and how many were preformed on young men with no underlying conditions that developed venous leak due to injury.  The thing I hate is oftentimes doctors base their treatment based on a few studies, but many times people don't look into the controls and the way in witch those studies were preformed.  

The Penile Sclerotherapy does look interesting.  

redbullmaster

Thought I give an update on my situation, saw Dr Franklin on the 3rd of Feb. for an examination.
I went in thinking I had a venous leak, but a duplex solography showed him that I didn't have a leak.
But it did show some calcified plaques, Said the curve may be stopping blood flow though the penis. But was honest and said that the main reason to have surgery is because the curve is likely to do more damage to the penis though intercourse. He recommend the stage surgery.

This would be my second surgery as I had surgery for congenital penile curvature 2 years ago, (Nesbit) which I'm not happy with the results. The curve returned since the surgery which I had on the NHS. I could have it done on the NHS for free, but it would be with my original surgeon.

I decided to use Dr Franklin Kuehhas. Who is considered one of the best surgeons for this condition, according to this board.

I had my operation on the 21 of Feb.

I found the cause of my soft glans/ED issue's. He said the issue I have is scare tissue pressing down on my veins stopping proper blood flow. said he hopes by straighten the penis it will allow more blood flow. He said he removed what he could, but its too close to the nerves and veins that's carrying the blood. The scaring not on the tunica, but the layer which covers it with the veins and nerve ending. Can't remove more, without causing more damage, so it isn't possible.

Says he thinks the scare issue is caused by the Nesbit operation I had before. He  said if I still have this issue, I should be trying daily cialis and ved in about four weeks to see if that helps. Will have to try to stay positive and hope for a good outcome.

What I will say even though its to early to say what the out come will be. It's like night and day with the treatment that I received with Dr Franklin, compared to my first operation which was traumatic to say the least. If your in the UK and are thinking of surgery I don't recommend the NHS route. I Know you paying a lot of money to go private with Dr Franklin, but the after care is worth it.

Even though my condition isn't related to a venous leak, if you have a soft head issue or ED you may have a similar problem to me.

Hope this helps    



james1947

redbullmaster

Thanks for the report.
You are now 16 days post operation, how are your nocturnal erection?
How is your pain from the surgery?

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

redbullmaster

Hi James,

Been taking Cyproterone Acetate to stop erection's, no pain from the surgery. Had some slight discomfort every now and then. But when I spoke to Dr Franklin after my surgery and the next day, if felt like I haven't even had surgery. Obviously there's still some swelling to go down and I do get some erection's, I've not been waking up in pain in the middle of the night like with the first surgery.
I don't no if the lack of pain is a good or bad thing, but was taking pain killers for the first seven days.

Haven't been obsessing about the erection's I have been getting. As until all the swelling gone down and I'm off the tablets it won't be a true erection.
The erection's I have been getting, are not full erection's.    

Redbullmaster

razor1

I have been diagnosed with a venous leak by doppler ultrasound, and am looking at going for sclerotherapy surgery with Dr Kuehhas next week.

Has anyone on here had the sclerotherapy surgery done with him ? Any results positive or negative to share ?

Thanks

redbullmaster

I still have the soft head issue and ED issues, does anyone think pentox could help along with traction?

james1947

redbullmaster

I think you should see Dr. Kuehass in the subject.
He may know better than forum members how to treat you.

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Pfract

coss: hello! i don't know currently of anyone that has had tha treatment in the aformentioned clinic, i am sorry. If you do decide to do it, or talk to the doctor about it, please let us know. It would be of great value to this community.

Good luck!

razor1


I've just been discharged after the surgery this morning and all seems to have gone well.

Both Dr Kuehhas and Prof Dr Herwig performed the operation which took about 45mins under local anesthetic.

They made a cut near the base of the penis, identified the deep dorsal vein, put in a catheter, injected the contrast and took an X-ray. They said there were a lot of veins showing the outflow and that it was as they expect to see due to the the venous leak. Unfortunately the nurse assistant forgot to print a copy of this for me.

They mixed the sclerotherapy agent and injected it, I was told to push like I was going to the toilet for a minute to keep the agent in the veins. This was repeated a second time.

The after X-ray was taken and showed minimal outflow & they printed this one for me.

I have been asked to abstain from sexual activities for 2 weeks, however he said nocturnal erections etc are fine. I will also need to take 5mg cialis for the next month.

They seemed pleased with the operation and results, so I'm really hoping it all turns out well once I'm recovered.

james1947

Coss

Please don't forget to update us how is going after the two weeks limit :)
Wish you full success with the treatment. :)

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

razor1

Sure James, I will update my progress.

Last night I got some swelling and bruising on my penis and at the top of the scrotum around the base. I have confirmed with Dr Kuehhas that this is normal and should disappear in a week or so. I have a bandage stuck over the cut still, and this should come off in another day or so. There is apparently smaller surgical tapes over the sutures which should stay on till they fall off. The suture are meant to dissolve in a few weeks.

There was some minor pain as the anesthetic wore off, and some discomfort afterwards. Just need to be careful to not bump it or exercise too much till it heals

razor1

Note: I have changed my profile name from coss to razor1 - which is the same I am using on other boards for consistency. Sorry if this adds any confusion.

James is it possible to update any posts in this thread with Coss and change it to razor1 ?

razor1

I'm just over 4 days now from the operation. I removed the large bandage (Dr said can remove after 2 days), but have left the surgical tape over the sutures (will leave it till it falls off). Swelling has gone down alot, and the bruising is also improving quite well. I have had some nocturnal erections - the first night or so they seemed rather weak, but seem to be improving each time. Am trying to not focus on that though and just let the healing process continue.

james1947

razor1/coss

You may update your posts by click on Modify button.

James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Pfract

That is so great to read! believe me it felt good to read such an account for the experience with this treatment. Hoping the experience is truly positive and improves your condition! Dr. Franklin does seem to be an amazing doctor. :)

razor1

Thanks pfract !

Still some bruising today mainly on the sides of the penis, it's improving slowly. There is a bit of minor pain around the cut and if I touch lower down the base of the penis from the cut where the deep dorsal vein would run it feels hard and quite sore/tender to touch, assume this is due to the sclerotherapy collapsing the vein.

Had some nocturnal erections last night and when I woke this morning, they seem to be a bit firmer than the night before. Hopefully this keeps improving over the next week+

razor1

My bruising is improving more today and the swelling has fairly much gone, although I still have some tenderness around the cut n below it on the base. The surgical tape is starting to peel off a bit, but I will just leave it until it falls off completely.

On a positive note - Was reading something quite erotic earlier and felt myself getting hard. I decided to check how firm it was and as i touched it got very hard. The glans were quite firm too, when they used to be always soft. I stood up, as often that would cause me to lose the erection and instead it became even harder. I stood for a few mins holding it so as to not put stress on the cut/stitches and it remained hard :D

It's still early days, but hopefully this is a good sign of things to come.

skunkworks

Thanks for the regular updates razor1, it will undoubtedly be very useful information for some.

I'm confused as to why they needed to make an incision though, reading about the procedure and watching cosmetic versions, IMO that should not have been necessary. New procedure though, they're probably still working out the kinks.

So far I think interventional radiology is still looking like the better option but that might change.
This is an emotionally destructive condition, we all have it, let's be nice to each other.

Review of current treatment options by Levine and Sherer]

razor1

Quote deleted by moderator - James
Please read the forum rules


Hi Skunkworks, I think it is to make sure the inject in the right vein, you wouldn't want to shut down an artery or wrong vein. Also you would want to miss the vein slightly or have any of the schelotherapy agent leak out

Pfract

Nice! Be able to maintain the erection for some time when you couldn't before... That's motivation right there! Let's hope for the best!! :-D

skunkworks

I just think, with a penis that has already shown it has issues with healing and circulation, it would be far better to minimise surgical trauma and use ultrasound guided injection. The description from another person on your thread on a different forum, describing them 'digging around' to get the right vein, not something I'd be game for with a penis that doesn't heal properly.
This is an emotionally destructive condition, we all have it, let's be nice to each other.

Review of current treatment options by Levine and Sherer]

razor1

Hi Skunkwork, here is some more info on the operation published by Prof Herwig (who was also performing the operation on me).

"After penile block with lidocaine a 1 to 2 cm penile dorsal midline incision was made at the penile base. The superficial dorsal vein was ligated. The deep dorsal vein was identified and isolated for about 2 cm length under the Buck´s fascia. The distal end was ligated with 4-0 Vicryl™ to prevent backflow into the glans penis and corpus Cavernosum.
Circumflexed veins, which branched off from the isolated portion of the deep dorsal vein at the penile
base, were ligated with 4-0 Vicryl™, too. The proximal end was catheterized with a 20 gauge steel needle.
The venous tract was confirmed by venography (Figure 1).
An air-block was set by antegrade injection of 1 ml air followed by 4 ml aethoxysclerol 3% for venoablation. The patient was asked to do a Valsalva maneuver for about 30- 60 seconds. The occluded dorsal vein and its occluded collaterals were visualized (Figure 2). The penile incision was anatomically closed with absorbable suture material."

Full text here:
http://transmedreports.org/index.php/aiua/article/view/aiua.2015.1.1/4563

Dared

Any more new razor? I have some venous leakage and may consider this procedure if all goes well for you...

razor1

I'm now just under 2 weeks post op:

My surgical tape was coming off a few days ago, so i removed it fully, there is small 1cm cut and it has a loop of thread at the top. Dr Keuhhas had said to me i could cut the thread in 10-14 days if it was still there. So I'm planning to wait a few days before deciding. The cut is still a little tender and slightly red tonight (I was on a plane all day in tight pants and kept getting erections while dozing off. I think it put some stress on the cut). I don't think it's healed enough for intercourse yet, maybe another week,

My erections have greatly improved though, I had soft glans for so many years, and now it kind of hurts they are getting so hard. I did some manual testing earlier and was able to get a rock hard erection, and maintain it, all while standing. I stopped occasionally and did a few things, and it stayed hard till I finished (rather than going soft as soon as any physical stimulation stopped). So to me that's a great improvement.

Of course time will tell, but right now I am happy with the improvement so far and it seems to be getting better each day. I am glad I went for the operation.

redbullmaster

Hi razor1,

Did Dr Kuehhas give you any idea if this treatment is long term or could it revert back in 6 months or a year?
Also if it does, would you get a discount or free second treatment?

Thanks as I'm thinking about this treatment, but the cost is putting me off.
As if it doesn't work that only leaves me the option of an implant, which is I think is about 11 thousand in the uk.

Hopefully it is the wonder cure it sounds like and yours is permanent fix.
     

yyy

razor please describe the soft glans issue that you had.
Just soft or also smaller glans when erect (respect to the shaft)?
Did you have cold glans when flaccid or erect?

Pfract

I quite didn't understand the part about "kept getting erections on the plane". I mean, i do get it,  but why do you have erections on a plane? lol But those are some good news. From everything i read having ED from a venous leak is such a difficult condition to treat. Hopefully this procedure is able to change that in a large scale.

Thank you again for these updates. They mean a lot to the community. Keep those good news coming!

By the way: your profile says you are from Singapore. By any chance do you know Dr. Geng Long Hsu, from Taiwan?

razor1

Quote from: redbullmaster on August 11, 2015, 03:57:19 PM
Did Dr Kuehhas give you any idea if this treatment is long term or could it revert back in 6 months or a year?
Also if it does, would you get a discount or free second treatment?
I asked him and he said it shouldn't reoccur. I think only time will tell, as far as I know he hasn't been performing this for more than a few years I think. It is different than vein ligation in the way it is injected into the dorsal vein & collapses many veins draining the penis and then xray is used to confirm outflow has been reduced/stopped. Ligation they seem to cut the veins they can see.

Quote from: yyy on August 11, 2015, 07:26:43 PM
razor please describe the soft glans issue that you had.
Just soft or also smaller glans when erect (respect to the shaft)?
Did you have cold glans when flaccid or erect?
My glans would be soft and not get hard, and would look and feel similar to when not erect (even with the shaft hard). This would be the same if I took PDE5 or even when Dr Keuhhas did the ultrasound with caverject injection.

Quote from: pfract on August 11, 2015, 09:27:09 PM
I quite didn't understand the part about "kept getting erections on the plane". I mean, i do get it,  but why do you have erections on a plane? lol But those are some good news. From everything i read having ED from a venous leak is such a difficult condition to treat. Hopefully this procedure is able to change that in a large scale.

Thank you again for these updates. They mean a lot to the community. Keep those good news coming!

By the way: your profile says you are from Singapore. By any chance do you know Dr. Geng Long Hsu, from Taiwan?
I kept getting erections on the plane, as I was falling asleep/dozing. I seem to have more nocturnal erections since the operation.

No sorry I don't know him

Stabler

Moderator since 2015- Missouri- I work in the medical field and have strong knowledge of insurance and how to obtain coverage for medication and other treatments. Being a woman I do not have Peyronies but you can ask me anything. I am happy to help.

Pfract

Hey razor1.how was this week in terms of recovery? Hope you have some good news!  :-)

redbullmaster

Hey razor1,

With my issue I feel when I'm erect I'm losing about half an inch in size, due to my penis not being fully erect. Have you noticed you length and girth being bigger than before the treatment or back to normal I should say?
As I'm guessing like me, your penis hasn't been it's true size due to insufficient blood flow.  


yyy

redubull, the length issue can derive also from Peyronie alone, not only from a venous leakage

Sham

Hi razor
Can u plz tell me where did u do ur surgery?
This would really help me man...I ve similar situation  

yyy


Sham

Thanks man!! U don't know how much hope I have gained seeing ur post....everyte
I would look online I would only get silly suggestion like PC muscle exercise or no porn masturvation....none of them worked...thanks man so much!!!

Btw does the surgery reduce penile length afterwards!!

And how much does the surgery cost in £

Rizzomc

This is really positive stuff. I'd only be concerned about the chance of recurring problems down the track like many of the vein ligating/embolising treatments.

My personal situation is weak erections and deflated glans that have been persistent for 7 months after a stupid decision to try a penis enlargement exercise (jelqing, boy have I regretted it ever since!)

Nothing I have tried that has been recommended on many forums has had any impact. Arginine and pycnogenol, DMSO and Iodine treatment, suggestions of pelvic floor stuff etc.
I took cialis 5mg for a month and that gave me firm erections, but the glans did not improve at all, remaining soft and deflated.

Has anyone else had similar problems?

Rizzomc

Razor just a couple of questions if you can answer please.
How much did the procedure cost?
Does anyone know if this can be done elsewhere? I'm in Australia!
Are you still taking the cialis? It will be interesting to see the effects once you stop using it.
Did/do you have peyronie's or was this from an injury or something?
Thanks.

Pfract

He has stopped answering in this thread. Either the results are so awesome that he is having sex everyday all day, or he is regretting the decision. Hope he comes back to give some feedback

redbullmaster

It costs £4000, the clinic is in Vienna and the price include the airfare and 1 night in a hotel. That's the UK price.  

skunkworks

Yeah he was posting on another forum also and stopped posting around Aug 11-12 so he's not just stopped postin g here.
This is an emotionally destructive condition, we all have it, let's be nice to each other.

Review of current treatment options by Levine and Sherer]

yyy

redbullmaster

how's your soft glans issue after the stage? any improvements so far? thanks

redbullmaster


yyy

I dont think you would get any benefit from the surgery for the soft glans. You should try other treatments like xiapex or PRP or pure STEM cells (difficult to find). Speak with dr Kuehhas about all this.  

redbullmaster

Hi, I've I spoke to Dr Kuehhas about this, he thinks I should have a cavernosgraphy to see what the issue is.
But its £350 and done in Vienna, then if there is a leak then the sclerotherapy.
I've tried PRP, did nothing for me, also Dr Kuehhas dismissed it as a treatment.
Xiapex is not been approved to be used on the outer part of the penis where my scare tissue is.
Did ask if pentox may help, but Dr Kuehhas says
"some of the newest publications on this issue have discovered
that the author of the initial publications on pentox has faked the
results..."