Long but here is the medical report copy/pasted from my interventional radiologist:
INTERVENTIONAL RADIOLOGY - INITIAL VISIT AND CONSULTATION
Reason for visit: Erectile Dysfunction
Subjective:
Chief Complaint: Patient is a 27 y.o. male who presents with erectile dysfunction
History of Present Illness: 27 y.o. male with difficulty achieving and maintaining erection. Pt states that he first noticed this after an injury he sustained to his penis while performing “jelqing” maneuvers 2 years ago. He was treated with cialis but was not pleased with the results. He has had extensive workup with an vascular MR eventually demonstrating venous leak. He underwent sclerotherapy to the dorsal vein which gave him transient improvement in symptoms, and subsequently underwent resection of the dorsal vein. He said this improved his ability to have an erection in the glans and distal penis but the proximal shaft had persistent symptoms. Following the surgery he had a repeat MRI which demonstrated persistent venous leak. He presents today for consultation for embolization of the venous leak.
Past Medical/Surgical History:
Patient has no past medical history on file.
Patient has no past surgical history on file.
Family History:
Patient family history is not on file.
Social:
Social history: He has no tobacco, alcohol, drug, and sexual activity history on file.
Allergies:
Patient has no allergies on file.
Contrast Allergy: No
Medications:
No current outpatient prescriptions on file.
No current facility-administered medications for this visit.
Review of Systems:
Complete ROS performed. All systems negative except as detailed in HPI or below.
History of Obstructive Sleep Apnea: No
Objective:
Physical Exam
Vital Signs:
BP Readings from Last 1 Encounters:
12/15/17
120/72
Pulse Readings from Last 1 Encounters:
12/15/17
68
Resp Readings from Last 1 Encounters:
No data found for Resp
Ht Readings from Last 1 Encounters:
12/15/17
6’ (1.829 m)
Wt Readings from Last 1 Encounters:
12/15/17
81.6 kg (180 lb)
Constitutional: no acute distress
Eyes: pupil equally round and reactive to light (PERRL) bilaterally
Cardiovascular: nondisplaced place of maximal impulse (PMI) and normal s1, s2
Respiratory: clear to auscultation bilaterally
Gastrointestinal: normal bowel sounds
GU: Male: normal testes
Musculoskeletal: normal gait
Extremity: no peripheral edema
Vascular: normal femoral pulse(s)
Psych: normal judgment and insight
Skin: no rash
Pertinent Laboratory Values:
No results for input(s): AFP, ALBUMIN, ALKPHOS, TBIL, DBIL, SGOTAST, SGPTALT, WBC, HEMATOCRIT, HGB, INR, PLTS, K, CREAT in the last 720 hours.
Performance Status: 0
BMI: Estimated body mass index is 24.41 kg/m² as calculated from the following:
Height as of this encounter: 6’ (1.829 m).
Weight as of this encounter: 81.6 kg (180 lb).
ASA Score: 1
Imaging Studies: OUtside pelvic MRA: Bilateral Penile arteries enhance normally, there is relatively less enhancement of the left cavernosal artery. Early filling of the right venous system is identifed.
Assessment:
This is an 27 y.o. male with venous leak resulting in ED.
Plan (Medical Decision Making):
I discussed the various treatment options for venous leak. 45 minutes was spent in consultation discussing alternative therapies including conservative management, surgery and embolization. Given the nature of the disease, I felt that the patient would be best treated with embolization at this time. The risks, benefits and alternatives were fully discussed including bleeding, infection and PE. Please do not hesitate to contact me if you have additional questions.
Narrative
History: 27 year old male with erectile dysfunction from venous leak
Anesthesia: 1% local lidocaine and moderate sedation.
Moderate conscious sedation was supervised by the performing
physician with the presence of independent radiology nursing
monitoring.
The patient received 6milligrams of Versed and 200micrograms of
fentanyl.
Physiological data monitoring was performed throughout the entire
procedure. The patient’s blood pressure, EKG, and pulse oximetry were
recorded. The patient was placed on 2liters of O2 via nasal cannula
throughout the entire procedure. The patient tolerated the procedure
and sedation without untoward reactions.
The intra-procedural sedation time it was 45 minutes.
Contrast:180ml Isovue 300.
Complication: None.
Procedure:
The procedure, risks, and benefits were discussed with the patient
and informed consent was placed in the chart. The patient was placed
in the supine position on the angiosuite bed and a “patient time-out”
was performed.
The patient’s bilateral groins were prepped and draped in the normal
sterile fashion. After anesthetizing with subcutaneous lidocaine, a
dermatotomy was performed over the femoral head. Using the Seldinger
technique, a 19-gauge singlewall needle was advanced into the right
common femoral artery. Under fluoroscopic guidance, a Bentson wire
was advanced into the abdominal aorta. The needle was then exchanged
for a 5 French vascular sheath and a side flush was started.
A 4F Glide cobra catheter was advanced into the abdominal aorta and
subsequently in the left internal iliac artery using up and over
technique. Diagnostic angiograms were performed. A microcatheter was
advanced and use to select the internal pudendal artery. Diagnostic
angiogram was performed. The Glide cobra was removed over a wire and
a 5F RUC catheter was advanced and formed in the aorta and
subsequently used to select the right internal iliac artery.
Diagnostic angiogram was performed. A microcatheter was used to
select the right internal pudendal artery and again angiograms were
performed.
At this point the wires and catheter were removed from the right
groin and the access was closed with a 5F vascade.
Ultrasound evaluation of potential access sites was performed. The
right common femoral and left common femeral veins were evaluated and
the determined to be patent. Concurrent real-time ultrasound
visualization was performed of the vascular needle entering the
vessel. Permanent recording and reporting of the saved image and
study into the PACS system was performed. Access was gained to the
bilateral common femoral veins using micropuncture technique. The
right was accessed first, a 5F sheath was exchanged for the
micropuncture sheath over an .035 wire. A 5F sheath was also
exchanged for the micropuncture sheath on the left groin.
A 4F glide cobra was advanced up the common iliac vein confluence
into the left internal iliac vein over a .035 glidewire. This was
exchanged for an rosen wire and a 6F destination sheath was advanced
over the iliac venous confluence. From the left groin a glide cobra
was advanced up and over the common iliac venous confluence into the
right internal iliac vein. This was then exchanged over a rosen wire
for a destination sheath. Diagnostic venograms were performed
bilaterally. A microcatheter was advanced through the parent catheter
into the left internal iliac vein and used to select the pudendal
vein and subsequently the periprostatic plexus. Diagnostic venograms
were performed. A second microcatheter was then advanced into the
right internal iliac vein and used to select the pudendal vein and
subsequently the periprostatic venous plexus. Diagnostic venograms
were performed. Based on these findings the left sided microcatheter
was placed in the center of the periprostatic plexus. This catheter
was copiously flushed with D5W. The periprostatic venous plexus was
then embolized with 0.6 mL of 1:2 concentration Glue:Lipiodol was
injected and then again copiously flushed with D5W to create a glue
cast filling the periprostatic plexus. The microcatheter was removed.
Diagnostic venograms were performed through the right sided
microcatheter demonstrating absence of flow in the periprostatic
plexus.
At this point all wires and catheters were removed. Hemostasis was
achieved with manual compression. Sterile dressings were placed.
The patient tolerated the procedure without complication and left the
Angio suite in stable condition.
Findings:
Left Internal iliac artery: Conventional branch anatomy
Left pudendal artery: No flow limiting stenosis or fistula
Right internal iliac artery: Conventional branch anatomy
Right Pudendal artery: No flow limiting stenosis or fistula
Left pelvic venogram: Filling of periprostatic plexus via multiple
collateral pelvic veins
Right pelvic venogram: Filling of periprostatic plexus via multiple
collateral pelvic veins
Radiation dose: DAP 56857 microGym2 , Flouro time: 43 minutes.
Impression
IMPRESSION:
1. Bilateral Internal iliac angiograms as described
2. Bilateral internal pudendal angiograms as described
3. Bilateral pelvic venograms as described
4. Successful embolization of periprostatic venous plexus with Glue.