A Case of Successful Treatment of Erectile Dysfunction

Turner-Mayer Syndrome: A Case of Successful Treatment of Erectile Dysfunction

A 23-year-old male presented to the andrology department at the “Men’s Consultation” clinic with complaints of erectile dysfunction.
The patient reported experiencing extremely unstable erections despite having a regular sexual life with a steady partner. Although he initially had good spontaneous erections, they would almost always disappear during intercourse, preventing him from sustaining sexual contact.

These issues led to psychological trauma and nervousness, further complicating sexual relations within the couple.
The patient began his sexual life at the age of 23. Initially, he engaged in 3–4 sexual acts per week with one partner and could achieve 2–4 ejaculations per day. However, after a month of this routine, the quality of his erections significantly deteriorated, becoming difficult to maintain. Even active sexual stimulation by his partner did not help develop an erection sufficient for penetration.

Visual sexual stimulation also elicited a very weak response, and the frequency of spontaneous erections significantly decreased.

The patient works as a dental technician in a sedentary job and leads a mostly inactive lifestyle without engaging in sports. He has no harmful habits and has not taken any medications.

The patient has a normal physique with a waist circumference of 90 cm. His external genitalia are formed in a masculine pattern. The scrotum is firm and elastic, with testicles measuring 2.5 × 4 cm. The epididymis is not enlarged. When the patient stood up, dilated veins of the pampiniform plexus were palpable on the left. During the Valsalva maneuver, where the patient had to exhale while straining his abdomen, the venous dilation increased.

Ultrasound examination revealed significantly dilated veins of the prostate gland up to 8–10 mm in diameter.

Doppler ultrasound of the scrotum identified dilated veins of the left spermatic cord (pampiniform plexus) up to 3.5–4 mm in diameter. It also detected retrograde blood flow lasting 4–5 seconds.

Prostate secretion analysis showed 2–3 leukocytes per field of view. Total testosterone level was 22 nmol/L, both within the normal range.


Erectile dysfunction due to circulatory disorders. Left-sided varicocele. Pelvic venous congestion. Chronic congestive prostatitis.

The patient was prescribed to take one tablet of Sildenafil 50 mg before sexual intercourse. However, there was no significant improvement, so the dosage was gradually increased to 100 mg.

A month-long course of treatment did not yield results. The patient was referred for further examination – pharmacodopplerography of the penile vessels. The study revealed venous leakage from the cavernous veins. There were no arterial abnormalities. Subsequently, the patient also underwent contrast-enhanced MRI, which showed:
• narrowing (stenosis) of the central part of the left common iliac vein to 3 mm over a length of 10 mm;
• in the distal segments, the vein dilated to 12 mm;
• venous plexuses of the prostate gland were dilated up to 8 mm.

Considering the new data, the patient was also diagnosed with Turner-Mayer Syndrome.

He consulted with a vascular surgeon, and it was decided to perform surgery. He underwent stenting of the left common iliac vein at the level of stenosis . After stenting, the patient was prescribed a course of anticoagulants.

Two months after the operation, the patient resumed his sexual life. Spontaneous erections were good and did not disappear during intercourse, and additional medication therapy was not required.

Anticoagulants were discontinued after six months. The patient continued to be monitored by a urologist for several years. During this period, the quality of erections completely recovered.

The patient also began actively engaging in physical exercise, performing aerobic exercises targeting the pelvic area. Control dopplerography of the scrotal vessels showed a decrease in the diameter of the left pampiniform plexus veins.

This clinical case demonstrates that the diagnosis of “erectile dysfunction” requires comprehensive diagnostics. This includes assessing the state of the circulatory system, as circulatory disorders can affect the onset and maintenance of erections. The presence of multiple and significantly dilated veins measuring 8–10 mm in diameter may serve as an indirect sign of stenosis.

Close cooperation between a urologist-andrologist and a vascular surgeon helps find solutions to the problems of patients with erectile dysfunction caused by circulatory disorders, especially if the pathology proves resistant to treatment with phosphodiesterase type 5 inhibitors.