Co esponding au ho : Emmanouil Dandoulakis
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Eme ging Pe spec i es on Male Geni al Vascula Mal o ma ions: F om Gene
Pa hways o Robo ic Su ge y
Emmanouil Dandoulakis *
Independen Medical Resea che , A hens, G eece.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1201-1207
Publica ion his o y: Recei ed on 06 July 2025; e ised on 14 Augus 2025; accep ed on 16 Augus 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.27.2.2951
Abs ac
Vascula de o mi ies o he male geni alia, including a e io enous mal o ma ions (AVMs), enous mal o ma ions, and
lympha ic anomalies, a e uncommon ye signi ican condi ions ha impac u ogeni al unc ion, sexual heal h, and
o e all quali y o li e. These condi ions may be congeni al o acqui ed and can p esen wi h symp oms such as pain,
swelling, e ec ile dys unc ion, and hemo hage. Recen ad ancemen s in diagnos ic imaging, gene ic analysis, and
minimally in asi e in e en ions ha e e olu ionized hei de ec ion and ea men .
This li e a u e e iew examines he classi ica ion, pa hophysiology, diagnos ic echniques, and ea men s a egies o
male geni al ascula de o mi ies. I syn hesizes da a om pee - e iewed jou nals, clinical ials, and ecen s udies o
p o ide a well- ounded analysis o medical p o essionals.
Keywo ds: Vascula mal o ma ions; Male geni alia; A e io enous mal o ma ions (AVMs); Venous mal o ma ions;
Lympha ic Mal o ma ions; Endo helial Dys unc ion; In lamma ion Ma ke s (TNF-α; IL-6); Gene ic Mu a ions (RASA1;
ENG; VEGF)
1. In oduc ion
Vascula anomalies in he male geni alia in ol e abno mal blood essel de elopmen ha dis up s no mal physiological
unc ion. These de o mi ies may be congeni al o acqui ed, and hei classi ica ion includes AVMs, enous
mal o ma ions, and lympha ic mal o ma ions. Ea ly ecogni ion is c i ical o p e en ing complica ions like e ec ile
dys unc ion, hemo hage, and ch onic pain.
Ad ances in gene ic esea ch and minimally in asi e he apies, such as emboliza ion and lase -assis ed echniques, a e
eshaping diagnos ic and ea men ou comes (Wasse , 2023).
2. Me hods
A sys ema ic li e a u e e iew was conduc ed using da abases such as PubMed, ScienceDi ec , and he Jou nal o
Vascula Su ge y, ocusing on a icles published wi hin he las 10 yea s. The sea ch e ms included “male geni al
ascula mal o ma ions,” “ es icula AVMs,” “sc o al enous anomalies,” and “penile ascula diso de s.” S udies
in ol ing gene ic analysis, no el imaging echniques, and in e en ional p ocedu es we e p io i ized.
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2.1.1. Inclusion & Exclusion C i e ia
This e iew included pee - e iewed s udies published in he las 10 yea s ocusing on male geni al ascula de o mi ies.
Only s udies wi h human subjec s, imaging-based diagnoses, and ollow-up da a we e conside ed. Exclusion c i e ia
included case epo s, animal s udies, and a icles wi hou ull- ex a ailabili y.
2.1.2. Quali y Assessmen
The me hodological quali y o selec ed s udies was e alua ed using PRISMA guidelines o sys ema ic e iews, QUADAS-
2 o diagnos ic accu acy, and he Coch ane isk-o -bias ool o andomized ials. These assessmen s examined s udy
design, po en ial biases, sample sizes, and da a consis ency o ensu e eliabili y and minimize bias in he syn hesized
indings.
2.1.3. Da a Syn hesis App oach
A quali a i e na a i e syn hesis was employed o in eg a e indings om di e se s udy designs. Whe e applicable,
s a is ical me a-analysis was conside ed o pooled es ima es. Key hemes, me hodological a iances, and clinical
implica ions we e sys ema ically compa ed, ensu ing a comp ehensi e e alua ion o diagnos ic accu acy, ea men
e icacy, and eme ging he apeu ic ends.
3. Findings
3.1. Classi ica ion and Pa hophysiology
• A e io enous Mal o ma ions (AVMs): High- low lesions caused by di ec a e y- o- ein connec ions,
leading o u bulence, hypoxia, and bleeding. Gene ic links include RASA1 and ENG mu a ions (G eene, 2024).
• Venous Mal o ma ions (VMs): Low- low dila ed eins ha may cause pain and swelling. VEGF o e exp ession
plays a key ole (Boon LM, 2020).
(Adap ed om (Helm M, 2022)
Figu e 1 MRI scan showing enous po ions in he sc o um and penis
• Immune-Media ed Vascula Impai men : Ch onic in lamma ion con ibu es o lesion g ow h and male
sexual dys unc ion by p omo ing endo helial damage (Calmasini, 2019).
3.2. Pa hophysiology & Molecula Mechanisms
• Gene ic & Molecula Mechanisms: Mu a ions in RASA1, ENG, and VEGF dis up key signaling pa hways like
Ras-MAPK and TGF-β, leading o abno mal essel p oli e a ion, angiogenesis, and s uc u al ins abili y. These
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 27(02), 1201-1207
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changes con ibu e o p og essi e lesion de elopmen and highligh he need o a ge ed molecula he apies
(Wasse , 2023).
• In lamma ion & Endo helial Dys unc ion: In lamma o y ma ke s like TNF-α and IL-6 impai endo helial
s abili y and d i e lesion p og ession h ough oxida i e s ess, apop osis, and VEGF-media ed angiogenesis.
Ta ge ed an i-in lamma o y s a egies may o e he apeu ic bene i (Calmasini, 2019).
• Lympha ic Mal o ma ions & Bioma ke s: These mal o ma ions a ise om aul y lympha ic d ainage and
may esul in ch onic lymphedema, in ec ion, and ib osis. MRI acili a es ea ly diagnosis. Ci cula ing ma ke s
like VEGF and mic oRNAs show p omise in p edic ing disease p og ession (Mallmann, M. R., and Gemb uch, U.,
2022); (Mo cel K, 2007)
Table 1 Vascula Anomalies in Male Ex e nal Geni alia
Pa ien
Age
(Yea s)
Symp oms
Lesion Loca ion &
Size (cm x cm)
Pa hology
Follow-up
(Mon hs)
Ou come
1
5
No
Sc o um, 1.8 x 1.4
Venous
mal o ma ion
6
No
ecu ence
2
19
No
Sc o um, 2.0 x 1.0
Lympha ic
mal o ma ion
2
No
ecu ence
3
22
No
Sc o um, 1.8 x 1.4
Venous
mal o ma ion
26
No
ecu ence
(Adap ed om (Khan M, 2023)
3.3. Imaging and Diagnos ic Techniques
Diagnos ic Challenges: Diagnos ic e o s a e common due o clinical and imaging o e lap be ween high- low
(AVMs) and low- low ( enous mal o ma ions) lesions. Ambiguous Dopple indings can delay app op ia e
ea men , emphasizing he need o ad anced imaging and AI-powe ed ools o imp o e accu acy.
• Dopple Ul asonog aphy: This i s -line ool di e en ia es high- low (AVMs) om low- low ( enous
mal o ma ions) by assessing eal- ime hemodynamics. AI-assis ed Dopple enhances diagnos ic accu acy by
quan i ying blood low and iden i ying sub le ascula changes, educing ope a o dependency and imp o ing
ea ly de ec ion.
• Magne ic Resonance Imaging (MRI): MRI p o ides de ailed so issue con as , ideal o de ec ing complex
ascula anomalies. Wi h AI-enhanced au oma ion and imp o ed con as di e en ia ion, i o e s g ea e
diagnos ic p ecision and e iciency.
• Compu ed Tomog aphy Angiog aphy (CTA): CTA is essen ial o p eope a i e planning due o i s de ailed
ascula mapping capabili ies. AI algo i hms now enhance image cla i y by educing mo ion a i ac s and
imp o ing he isualiza ion o small essels, aiding in p ecise su gical s a egy.
Table 2 Compa ison o Imaging Techniques o Diagnosing Vascula De o mi ies
Imagine Technique
Ad an ages
Limi a ions
Dopple Ul asonog aphy
Real- ime assessmen , widely a ailable, non-
in asi e
Limi ed in deep issue
isualiza ion
Magne ic Resonance Imaging
(MRI)
High- esolu ion so issue con as , use ul o
complex anomalies
Expensi e, ime-consuming
Compu ed Tomog aphy
Angiog aphy (CTA)
P o ides de ailed ascula mapping, use ul o
su gical planning
High adia ion exposu e,
equi es con as dye
Con as -Enhanced Ul asound
(CEUS)
Imp o e isualiza ion o ascula low
dynamics
Limi ed a ailabili y in some
medical cen e s
AI-Powe ed Dopple Analysis
Enhances blood low in e p e a ion, educes
misdiagnosis
Dependen on machine lea ning
model accu acy
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3D Vascula Mapping
Imp o es p ecision in lesion cha ac e iza ion
and ea men planning
Requi es specialized imaging
so wa e
Func ional MRI ( MRI)
Assesses eal- ime pe usion and issue
iabili y
High cos , limi ed clinical
accessibili y
(Adap ed om (RSNA, 2022) and (Khan M, 2023)
• Ad anced Imaging Techniques: Recen ad ancemen s include:
• Func ional MRI ( MRI): Func ional MRI ( MRI) p o ides eal- ime assessmen o ascula unc ion and
pe usion. AI-powe ed MRI ad ancemen s now imp o e eal- ime ascula pe usion assessmen by
enhancing signal accu acy and il e ing ou mo ion a i ac s. Machine lea ning algo i hms enable dynamic
blood low quan i ica ion, assis ing in dis inguishing be ween iable and non iable issue c ucial o
ea men decision-making and su gical planning. (Gup a A, 2020), (Ho man K, 2023)
• Con as -Enhanced Ul asound (CEUS): CEUS u ilizes con as agen s o enhance he isualiza ion o
ascula low, imp o ing he di e en ia ion o ascula mal o ma ions om o he so issue abno mali ies.
This echnique has p o en e ec i e in diagnos ic p ecision, especially in complex cases (RSNA, 2022).
• 3D Vascula Mapping: 3D ascula mapping econs uc s ascula a chi ec u e, enabling p ecise
cha ac e iza ion o lesion s uc u e and dis ibu ion. When in eg a ed wi h AI echnology, i imp o es
anomaly de ec ion, educes su gical isk, and enhances p eope a i e planning by o e ing de ailed isual
da a. I s p ecision suppo s mo e ailo ed and e ec i e clinical in e en ions (Ho man K, 2023).
• Di usion Tenso Imaging (DTI): DTI p o ides ad anced imaging o ne e ac in ol emen in ascula
mal o ma ions. I assesses he in eg i y o neu al pa hways, guiding clinicians in iden i ying po en ial isks
and op imizing su gical app oaches. This echnique helps p e en pos ope a i e neu ological de ici s and
suppo s p ecise lesion esec ion (Gup a A, 2020).
• AI-Assis ed Image Segmen a ion & Machine Lea ning Analy ics: This dual app oach u ilizes AI o
enhance diagnos ic p ecision. Segmen a ion algo i hms ou line lesion ma gins mo e accu a ely, enabling
a ge ed ea men s and educing isks o heal hy issues. Machine lea ning models analyze imaging
pa e ns o de ec anomalies ea ly, imp o e classi ica ion accu acy, and educe diagnos ic a iabili y ac oss
clinicians.
• High-Resolu ion Op ical Cohe ence Tomog aphy (OCT): OCT deli e s mic o-le el imaging o ascula
s uc u es in eal ime, making i in aluable o e alua ing supe icial lesions in he male geni alia. I assis s
in dis inguishing lesion bounda ies du ing minimally in asi e in e en ions and enables ongoing
moni o ing o ea men esponse, educing he need o epea imaging. (Ho man K, 2023).
Table 3 Summa y o Imaging Modali ies o Vascula Mal o ma ions
AI-D i en Imaging
Technique
Clinical Bene i s
Impac on Diagnosis & T ea men
AI-Powe ed Dopple Analysis
Enhances low assessmen , educes
human e o
Imp o es accu acy in dis inguishing
high/low- low lesions
3D Vascula Mapping
Allows de ailed isualiza ion o
complex anomalies
Op imizes p e-su gical planning and
in e en ion
Func ional MRI ( MRI)
E alua es eal- ime pe usion changes
Helps di e en ia e iable s. non iable
issue
AI-Assis ed Image
Segmen a ion
Imp o es lesion bounda y de ec ion
Enhances p ecision in in e en ional
p ocedu es
Machine Lea ning in Imaging
Analy ics
Au oma es anomaly de ec ion,
s anda dizes diagnos ics
Reduces a iabili y in diagnosis, aiding
ea ly de ec ion
(Compiled om he li e a u e e iew indings in his s udy) No e: These imaging ad ancemen s o e a ge ed diagnos ic capabili ies ha
signi ican ly imp o e clinical accu acy and guide in e en ion planning o male geni al ascula de o mi ies.
• Gene ic Bioma ke s & Molecula Tes ing: Ci cula ing bioma ke s such as VEGF, mic oRNA signa u es, and
exosomal ma ke s a e gaining ac ion in p edic ing disease p og ession and ea men esponse. These
bioma ke s, pa icula ly when in eg a ed wi h AI-d i en diagnos ic pla o ms, o e po en ial o ea ly
de ec ion, moni o ing, and pe sonalized he apeu ic s a egies in male geni al ascula mal o ma ions (Mo cel,
2007).
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3.4. T ea men S a egies
• Emboliza ion The apy: This minimally in asi e me hod in ol es injec ing embolic agen s o block abno mal
ascula connec ions, especially in AVMs. I educes in aope a i e bleeding by app oxima ely 50% and
enhances su gical sa e y when used p eope a i ely (Khalil, 2022).
• Conse a i e Managemen : This ca ego y includes non-su gical in e en ions aimed a symp om elie and
ascula unc ion es o a ion.
• Endo ascula Techniques such as balloon angioplas y, ca he e -di ec ed h ombolysis, and s en ing help
es o e ascula low, elie e conges ion, and imp o e ci cula ion (Nguyen, T. Q., and Monahan, P. E., 2015).
• Comp ession The apy using ga men s o bandages educes swelling, imp o es enous e u n, and
suppo s eco e y pos -scle o he apy (A a an, R. R., and Ochoa Chaa , C. I., 2017).
• Pain Managemen in ol es NSAIDs o in lamma ion, opioids o se e e pain unde supe ision, and
suppo i e he apies like physical and psychological ca e (Simpson, K. H., and Al-Ku oubi, A., 2016).
Table 4 Indica ions o T ea men o Male Geni al Vascula Mal o ma ions
Pa ien
Swelling
(Yes/No)
Lympho hea
(Yes/No)
Skin In ol emen
(E ysipelas (E),
Lymphangioma
Ci cumsc ip um (L),
Bleeding (B),
Th ombophlebi is
(T))
Pain
(Yes/No)
Speci ic
Geni ou ina y
Symp oms
Main
Symp om o
T ea men
1
Yes
Yes
L
No
Dysu ia
Func ion
2
Yes
Yes
E
No
__
In ec ion
3
Yes
Yes
L, E
No
__
In ec ion
4
Yes
No
N/A
No
__
Dis igu a ion
5
Yes
No
N/A
Yes
__
Pain
6
Yes
No
N/A
No
Dysu ia
Func ion
7
Yes
No
B, T
Yes
Algu ia
Pain
8
Yes
No
B
Yes
Hema u ia
Pain
(Adap ed om (Mazoye J, 2023))
• Image-Guided Pe cu aneous Scle o he apy: Clinical s udies epo his echnique as e ec i e in achie ing
subs an ial symp om elie and lesion size educ ion, pa icula ly in low- low mal o ma ions (Mazoye J, 2023).
• No el The apeu ic S a egies:
• Si olimus The apy: Clinical ials show ha Si olimus, an mTOR inhibi o , signi ican ly educes symp oms
in pa ien s wi h slow- low ascula mal o ma ions (G eene AK, 2023).
• Gene The apy: Expe imen al he apies a ge ing RASA1 and ENG mu a ions show p omise o long- e m
ascula emodeling. As his ield e ol es, molecula diagnos ics and gene ic p o iling may suppo
pe sonalized, less in asi e ea men planning (Ho man K, 2023).
• Scle o he apy: Scle o he apy is a on line ea men o enous mal o ma ions, using scle osan s o induce
ib osis and essel closu e. S udies show 75% symp om esolu ion, wi h ecu ence a es depending on lesion
ype (Ha ipoğlu, N., and Ku oğlu, S., 2013). Ad ances like e hanol-based and polidocanol oams ha e imp o ed
ou comes, while ul asound and luo oscopic guidance enhance p ecision and educe complica ions.
• Su gical In e en ions: Su gical In e en ions: Rese ed o la ge o esis an lesions, su gical esec ion has
a 30 - 40% ecu ence a e o AVMs i a e ial in low isn' con olled (Khalil, 2022). P eope a i e emboliza ion
has been shown o educe in aope a i e bleeding by 50%, imp o ing su gical sa e y and educing pos -
su gical complica ions. P eope a i e emboliza ion cu s in aope a i e bleeding by 50%. Howe e , isks such as
h ombosis, ne e inju y, and skin nec osis equi e coo dina ed, long- e m ca e.
• Robo -Assis ed Su ge y: Robo ic mic osu ge y o e s 92% p ecision in complex o deep lesions, educing
auma, blood loss, and eco e y ime (Calmasini FB, 2023). Enhanced dex e i y and isualiza ion imp o e
ou comes, hough high cos s and aining demands limi b oade adop ion.
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Table 5 E icacy o T ea men S a egies o Male Geni al Vascula Mal o ma ions
T ea men Me hod
Success Ra e
(%)
Key Bene i s
Limi a ions & Risks
Emboliza ion The apy
~80%
Reduces in aope a i e bleeding
by 50%
Pa ial occlusion, po en ial o
ecu ence
Scle o he apy
75%
Non-su gical, e ec i e o
enous mal o ma ions
Risk o issue nec osis and
lesion ecu ence
Robo -Assis ed Su ge y
92%
p ecision
Minimally in asi e, high
accu acy in deep lesions
High cos , limi ed a ailabili y
Su gical Resec ion
60–70%
Bes o la ge, symp oma ic
lesions
30 - 40% ecu ence isk,
po en ial ne e damage
Gene The apy
(Expe imen al)
N/A
Po en ial o long- e m ascula
emodeling
S ill in ea ly esea ch phase,
unp o en e ec i eness
Ta ge ed Molecula The apy
(Expe imen al)
N/A
Pe sonalized ea men , a ge s
disease mechanisms
Limi ed clinical ials, unce ain
long- e m ou comes
(Sou ce: Syn hesized om li e a u e e iew indings)
• Ta ge ed Molecula The apy: Recen ad ancemen s in pe sonalized medicine ha e in oduced gene- a ge ed
he apies ha add ess he unde lying molecula mechanisms o ascula anomalies. Expe imen al ea men s
in ol ing VEGF inhibi o s, si olimus-based mTOR inhibi o s, and TGF-β pa hway modula o s ha e shown
p omise in p eclinical and ea ly clinical ials (G eene, 2024).
4. Discussions
4.1. Compa ison Wi h O he Sys ema ic Re iews
Unlike p e ious e iews ha ocused p ima ily on adi ional imaging and ea men me hods, his s udy in eg a es
ecen ad ancemen s in molecula diagnos ics and AI-d i en imaging. By emphasizing a ge ed gene he apy and
machine lea ning applica ions, i p o ides a mo e upda ed pe spec i e on ascula mal o ma ions (G eene, 2024).
Despi e echnological ad ancemen s, signi ican knowledge gaps emain, pa icula ly in he long- e m ou comes o
eme ging he apies, s anda dized diagnos ic c i e ia, and he gene ic unde pinnings o lesion a iabili y.
4.2. Fu u e Di ec ions
The u u e o ascula mal o ma ion ea men lies in in eg a ing AI-d i en diagnos ics, gene he apy, and obo ic
mic osu ge y. AI-powe ed imaging enhances ea ly de ec ion, while gene he apy a ge ing VEGF and RASA1 mu a ions
shows p omise in lesion eg ession. Robo ic-assis ed mic osu ge y o e s p ecision in complex cases, minimizing
complica ions. Howe e , he lack o s anda dized guidelines limi s widesp ead adop ion. To e ine ea men p o ocols,
la ge-scale mul icen e clinical ials a e essen ial. These ials will alida e he e icacy o no el he apies, imp o e
pa ien selec ion c i e ia, and es ablish e idence-based guidelines o pe sonalized ea men , ensu ing be e long-
e m ou comes o pa ien s wi h male geni al ascula mal o ma ions (Calmasini FB, 2023).
These e o s will s eng hen he in eg a ion o p ecision medicine and echnology-d i en ca e in o clinical p ac ice.
5. Conclusion
Male geni al ascula mal o ma ions ep esen a a e bu clinically impac ul domain, whe e ea ly diagnosis and
pe sonalized in e en ions a e c i ical. This e iew unde sco es he impo ance o in eg a ing AI-d i en imaging, gene-
a ge ed he apies, and obo ic-assis ed p ocedu es in o mains eam ca e. These echnologies no only enhance
diagnos ic p ecision and ea men e icacy bu also educe in asi eness and eco e y ime. Despi e p omising
ad ances, s anda dized guidelines emain lacking, and long- e m e icacy da a is limi ed. Con inued esea ch, especially
la ge-scale, mul icen e s udies, will be essen ial in b idging hese gaps.
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Ul ima ely, a u u e g ounded in p ecision medicine, inno a ion, and mul idisciplina y collabo a ion o e s he mos
p omising pa h o wa d in managing hese complex ascula de o mi ies.
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