Successful Treatment of Glans Tumescence Dysfunction Caused by Abnormal Venous Communication Between the Great Saphenous Vein and the Deep Dorsal Vein: A Case Report.

Abstract

Background: Penile venous abnormalities are an uncommon cause of erectile dysfunction and are rarely implicated in isolated glans tumescence impairment. We report what may be the first successful surgical treatment of glandular tumescence dysfunction caused by an anomalous venous communication between the deep dorsal vein of the penis and the left great saphenous vein.

Case presentation: A 42-year-old man presented with lifelong inadequate glans tumescence and mild erectile maintenance difficulty (International Index of Erectile Function-5 score, 18). Physical examination and hormonal evaluation were unremarkable. Dynamic penile color Doppler ultrasonography after intracavernosal prostaglandin E1 demonstrated normal cavernosal arterial inflow and preserved cavernous veno-occlusive function but showed markedly increased flow in the deep dorsal vein despite rigid shaft erection and persistent poor glans engorgement. Dynamic cavernosography identified an isolated anomalous collateral vessel connecting the deep dorsal vein to the left great saphenous vein, with no additional venous leakage sites. Surgical correction consisted of ligation and excision of the anomalous collateral vein, excision of the deep dorsal vein through an anterograde penile skin degloving approach, and selective ligation of cavernous veins.

Conclusions: The patient reported complete restoration of glans tumescence at 1 month, sustained at 1 year, with improvement of the International Index of Erectile Function-5 score from 18 to 23. This case highlights the diagnostic value of cavernosography in selected patients with discordant findings between shaft rigidity and glans engorgement and suggests that targeted surgical correction may be effective when a highly localized venous shunt is identified.