Abstract
Erectile dysfunction (ED) is a big issue in various populations with up to 30% of young men suffering from this condition. Unfortunately, treatment schemes are currently mainly focused on elderly patients with chronic disorders. In younger patients, ED is more a vascular problem, which affects the storage capacity of the penis. The impact of penile blood supply on erectile function was recognized some 500 years ago. At the turn of the twentieth century, the first results of penile venous ligation were published. Simple isolated ligation of the deep dorsal vein in humans for ED due to venous leak is currently not recommended, due to some reported low long-term success rates. This was, as shown in several literature reports, obviously due to insufficient technical possibilities. Technical development in imaging and vascular and endovascular treatment have dramatically evolved our understanding of this underlying condition in the past 20 years and turned this disease into a long-term treatable condition. The current state-of-the-art work-up of the underlying condition, using the newest imaging technologies with color Doppler ultrasound and CT scan with additional three-dimensional reconstruction, is to show the surgeon exactly the points to focus on. Additionally, a so-called corporo-venous insufficiency can be recognized as a mainly combined condition, affecting peripheral and more proximal drainage pathways at the same time.