Penile cavernous venous leak is one of the main causes of organic impotence, but its diagnosis is somewhat difficult. Color bifunctional ultrasonography has some diagnostic value for venous leaks, but it is an indirect way to determine the display of venous leaks. In contrast, penile cavernosography can directly understand the venous return and observe the presence of venous leakage, which has special value in the diagnosis of venous impotence. 1.What should a normal person’s cavernosography image look like? A firm erection requires adequate arterial blood supply on the one hand and good venous closure function on the other. As shown on the left side of the figure below, when the penis is weak, the arteries are closed, less blood enters the penis, the pressure in the penile corpus cavernosum is low, and the veins are dilated. When the penis is erect (right side of the figure below), on the other hand, the arteries expand, the blood entering the corpus cavernosum increases significantly, the cavernous sinuses are filled with blood, and the pressure rises. Due to the limited stretch of the white membrane, the veins are squeezed and closed. At this point the cavernous veins flow very little blood and are essentially a closed chamber. If contrast is injected while the penis is in an erect state in a normal person, the contrast is confined to this closed chamber of the penis. Therefore, except for the penile corpus cavernosum, the urethral corpus cavernosum and other parts of the penis will not show contrast, that is, they will not develop. The black color is the penile corpus cavernosum, and the contrast agent is left inside the corpus cavernosum without spilling out, and the urethral corpus cavernosum and surrounding tissues are not visualized (as shown below). 2.Which venous diseases can be diagnosed by contrast: Combined with the above, the contrast agent appears outside the penile corpus cavernosum is abnormal, and there is a leak. The location of the venous leak can be diagnosed by contrast examination, thus providing the basis for further treatment. The figure below shows various abnormal contrast images: for example, if the urethral corpus cavernosum is also visualized, it means that there is a leak between the penile corpus cavernosum and the urethral corpus cavernosum and there are abnormal traffic vessels; other abnormal images include prostatic venous plexus visualization, superficial skin vein visualization, internal iliac vein visualization, and other abnormal images. Usually, if the venous leak is relatively limited, it can be treated surgically and the result will be relatively good. 3, those who want to do penile cavernosography: cavernosography is a certain indication, if during sexual intercourse is slow or difficult to start erection, decreased hardness, erection does not last, there may be vascular dysfunction, so you need to do imaging to further confirm the diagnosis. According to research analysis, more than two-thirds of organic impotence is due to venous leakage. In such patients, further ultrasound Doppler examination is required. If the ultrasound examination reveals excessive venous blood flow, it indirectly indicates the presence of venous leakage. The specific location of the venous leak can be clarified by doing another imaging. 4.What to pay attention to when doing the imaging: The imaging needs to be done in a quiet and comfortable environment, especially the patient should not have ideological concerns, which can lead to insufficient erection and affect the effect of the imaging. After the injection of erection-boosting drugs, the contrast is injected when the penis is fully erect, the flow of contrast is dynamically observed, and films are taken. After the examination, it is necessary to press (not rub) the needle site for 3-5 minutes to avoid hematoma. After releasing the pressure, it is necessary to observe for 2-3 minutes. After that, you can walk around, squat repeatedly and other exercises to help the penis speed up the rate of weakness. 5.What are the risks of doing this test: Venous leakage is a very safe test, the main risks include abnormal penile erection, infection, penile hematoma and allergic reactions and so on. However, as long as the procedure is strictly followed, the incidence of risk is very low and controllable. Generally speaking, people with poor coagulation (such as those who take anticoagulant aspirin for a long time), infected wounds on the skin near the penis, or those with allergies need to be cautious when having cavernous angiography.