DESCRIPTION
During erection of the penis, blood flow into the corpora cavernosa increases dramatically. The rapid filling of the cavernosal spaces compresses venules resulting in decreased venous outflow. The combination of increased inflow and decreased outflow rapidly raises intracavernosal pressure. This results in progressive penile rigidity and full erection. Venous incompetence of outflow restriction causes an incomplete or rapid loss of erection. The penile venous occlusive procedure or penile vein ligation has been investigated to prevent this from occurring.
POLICY
Penile venous occlusive procedure for the treatment of impotency is considered investigational.
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
Policies with similar titles: Erectile Dysfunction - Penile Revascularization
ADDITIONAL INFORMATION
Scientific evidence in the form of published articles in peer-reviewed journals are lacking regarding long-term outcomes and long-term adverse events.
SOURCES
American Urological Association. (2007). Erectile dysfunction. The management of erectile dysfunction: An update. Retrieved November 12, 2007 from http://www.auanet.org/guidelines/main_reports/edmgmt/chapter1.pdf.
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2002). Erectile dysfunction (2.01.25). Retrieved November 15, 2007 from BlueWeb. (1 article and/or guidelines reviewed)
Cakan, M., Yalcinkaya, F., Demirel, F., Ozgunay, T., & Altug, U. (2004). Is dorsale penile vein ligation (dpvl) still a treatment option in veno-occlusive dysfunction? International Urology and Nephrology, 36 (3), 381-387. Abstract retrieved November 15, 2007 from PubMed database.
Complete Guide to Medicare Coverage Issues [Computer software]. (2007, July). Diagnosis and treatment of impotence. (NCD 230.4, p. 2-183). St. Anthony Publishing.
Coughlin, L. (2006). Practice guidelines. AUA updates guidelines on management of erectile dysfunction. American Family Physician, 73 (2), 342-346.
National Guideline Clearinghouse. (2006, May). The management of erectile dysfunction: An update. Retrieved November 13, 2007 from http://www.guidelines.gov.
Sadeghi-Nejad, H., Brison, D., & Dogra, V. (2007). Male erectile dysfunction. Ultrasound Clinics, 2 (1), 57-71.
Tsao, C. W., Lee, S. S., Meng, E., Wu, S. T., Chuang, F. P., Yu, D. S., et al. (2004). Penile blunt trauma induced veno-occlusive erectile dysfunction. Archives of Andrology, 50 (3), 151-154. Abstract retrieved November 15, 2007 from PubMed database.
ORIGINAL EFFECTIVE DATE: 4/27/1998
MOST RECENT REVIEW DATE: 12/13/2007
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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