Dynamic infusion cavernosometry and cavernosography for classifying venous erectile dysfunction and its significance for individual treatment

Erectile dysfunction (ED) affects over 30 million men in the U.S. alone, with venous erectile dysfunction (VED) – a type caused by the penis’s inability to retain blood during an erection – being a common yet underrecognized contributor. For years, doctors struggled to accurately diagnose VED severity and match patients to the right treatments. But a 2019 study from Chinese researchers offers a breakthrough: a specialized test called dynamic infusion cavernosometry and cavernosography (DICC) can not only diagnose VED but also guide personalized care based on how mild or severe the condition is.

Led by Qing-Qiang Gao (Department of Andrology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School) and Jian-Huai Chen (Department of Andrology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine), the study was published in the Chinese Medical Journal and involved 147 men aged 19–48 with persistent ED (6 months to 6 years) and stable heterosexual relationships. All had abnormal morning/nocturnal erections (via RigiScan) and color Doppler duplex ultrasonography (CDDU) results showing good arterial blood flow to the penis but high venous outflow – a hallmark of VED.

What Is VED, and Why Is Diagnosis Hard?

VED occurs when the veins in the penis fail to “shut off” during arousal. Normally, during an erection, blood flows into the penis’s spongy tissue (corpora cavernosa) and veins compress to keep blood in. For VED patients, these veins leak, letting blood escape and preventing a firm, lasting erection.

CDDU – a common test that uses ultrasound to measure blood flow – is often used to check for VED, but it can produce false positives (wrongly labeling someone as having VED). DICC is considered the “gold standard” for VED diagnosis: it involves infusing fluid into the penis while measuring intracavernous pressure (ICP) and how fast fluid is needed to maintain an erection (flow-to-maintain, FTM). If pressure drops quickly when infusion stops (pressure decay, PD), it signals a venous leak.

Before this study, however, there was no standardized way to use DICC to classify VED severity or guide treatment. The team set out to change that.

How the Study Worked

The researchers developed a step-by-step DICC protocol:

Anesthesia & Setup: Patients received local anesthesia (lidocaine) at the base of the penis. Small needles were inserted to measure pressure (ICP) and infuse a saline-dye mixture.
Fluid Infusion: Doctors infused fluid at increasing speeds (up to 4.9 mL/s) until the penis was erect or the patient reported discomfort. They recorded FTM (how fast fluid was needed to stay erect) and PD (pressure drop 30 seconds after stopping infusion).
Imaging: X-rays (normotopia, left/right oblique views) were taken to visualize vein leakage.

Based on DICC results, patients were grouped into four categories:

Non-VED: No vein leakage (FTM < 0.5 mL/s, PD < 20 mmHg) – 23 patients.
Mild VED: Minimal leakage (FTM 1.0–1.5 mL/s, PD 40–70 mmHg) – 51 patients.
Moderate VED: Moderate leakage (FTM 1.5–2.0 mL/s, PD 70–100 mmHg) – 44 patients.
Severe VED: Severe leakage (FTM ≥ 2.0 mL/s, PD ≥ 100 mmHg) – 29 patients.

All patients tried psychotherapy first (to address stress or anxiety contributing to ED). If that didn’t work, they moved to:

Drug therapy: Tadalafil (Cialis), a PDE-5 inhibitor taken every other day for 3–4 weeks.
Interventional embolization: Blocking leaky veins with a glue-iodized oil mixture (inserted via a catheter into the femoral vein).
Penile prosthesis implantation: Surgically placing a device to help achieve erections (for severe cases).

Key Results: DICC Guides Better Treatment

The team followed patients for 3–12 months and used the International Index of Erectile Function-5 (IIEF-5) – a widely used questionnaire to measure ED severity – to track outcomes. Here’s what they found:

1. Non-VED Patients: Psychotherapy and Drugs Worked

Of the 23 non-VED patients (no actual vein leakage), psychotherapy improved IIEF-5 scores from 15.3 to 19.4 (a significant jump). Drug therapy worked even better, raising scores from 16.6 to 23.3 (nearly the maximum score of 25).

2. Mild VED: Drugs and Embolization Helped

For 51 mild VED patients:

Drugs: IIEF-5 scores rose from 15.8 to 19.4 (effective).
Embolization: For 8 patients who tried it, scores improved from 15.5 to 18.3 (statistically significant).

3. Moderate VED: Embolization Was Mixed, but Prosthetics Worked

Of 44 moderate VED patients:

Drugs: No improvement (scores stayed ~11–12).
Embolization: For 6 patients, scores rose from 11.8 to 14.8 (not statistically significant).
Prosthetics: For 5 patients who got implants, scores jumped from 13.8 to 24.0 (nearly perfect).

4. Severe VED: Only Prosthetics Helped

For 29 severe VED patients:

Drugs/Embolization: No improvement (scores stayed ~7–8).
Prosthetics: For 8 patients, scores skyrocketed from 8.0 to 23.3 (life-changing results).

Why This Matters for VED Patients

The biggest takeaway? DICC is more than a diagnostic tool – it’s a roadmap for treatment. The study confirms that:

Mild VED responds well to oral medications (like tadalafil).
Moderate VED may need embolization, but prosthetics are more reliable.
Severe VED almost always requires a penile prosthesis (drugs and embolization don’t work).

This personalized approach means fewer “trial-and-error” treatments and better outcomes. For example, a severe VED patient who might have wasted months on pills can skip straight to a prosthesis – the only treatment that works for their case.

Limitations and Next Steps

The study isn’t perfect: Embolization didn’t help severe VED patients (likely because their vein damage was too extensive), and the team notes that DICC still needs more standardized protocols. But the results are a big step forward for VED care.

As the researchers write: “DICC is a valid diagnostic tool that can identify VED patients and guide individual therapy. More studies are needed to refine the procedure, but this work shows how precision medicine can improve ED treatment.”

Final Thoughts

For men with VED, the frustration of trying treatments that don’t work is all too common. This study offers hope: DICC can take the guesswork out of diagnosis and connect patients to the right care faster. Whether it’s pills for mild cases or a prosthesis for severe ones, the goal is clear: help men regain confidence and intimacy.

The study was funded by the National Natural Science Foundation of China (No. 81701433), the Project of Nanjing Municipal Bureau of Health (No. YKK17098), and the Fundamental Research Funds for the Central Universities (No. 021414380134). No conflicts of interest were reported.

To read the full study, visit doi.org/10.1097/CM9.0000000000000099.

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