Ambulatory Strategies for Reconstructing Penile Morphological and Erectile Function
Geng-Long Hsu1,2,4, Cheng-Hsing Hsieh3, Hong-Chiang Chang4, Pei-Ping Tsai2, Ming-Tsun Chen2
Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology1
,Yin Shu-Tien Memorial Hospital Shu-Tien Urology Ophthalmology Clinic2
, Department of Urology Taipei Tzuchi Hospital3 and National Taiwan University hospital4, Taipei, Taiwan
Purpose: Acceptable penile morphology and erectile function are indispensable for male sexual health. Given the conventional penile anatomy overlooked some key fibro-vascular structures such as the outer tunica of corpora cavernosa, two cavernosal veins (CVs) and four para-arterial veins (PAVs); its derived therapeutic strategies might not be sustainable for reconstructing sexual health because no corpora-veno-occlusive function can be reached if those structures negate. We sought to overview updated-anatomy-based penile corporoplasty (PC), penile venous stripping (PVS), penile augmentation (PA) and penile implant (PI) in the recent decade.
Material and Method: From 2011 to 2019, 335, 183, 93 and 57 consecutive patients received PVS, PC, PA and PI respectively. All surgeries were based on the updated penile anatomy that is bi-layered tunica with 360° inner circular layer and 300° outer longitudinal layer surrounding the corpora cavernosa and one deep dorsal vein, one pair of CVs and two pairs of PAVs between the tunica albuginea and Buck’s fascia. Acupuncture was first applied to HeGu (LI 4), ShouSanLi (LI 10) and WaiGuan (SJ 5). Manual needle stimulation was made while the exact injection of proximal dorsal nerve, peripenile, and cavernosal nerve block was made. The pain level was assessed with a 100 mm visual analog scale (VAS). The assessing parameters were the abridged 5-item version of the International Index of Erectile Function (IIEF-5), erection hardness scale (EHS)and pharmaco-cavernosography if required.
Results: An ambulatory outpatient strategy was unexceptionally used. In the PVS group, there was statistically significant between preoperative and postoperative treatment (n=328, 9.5 ± 2.2 vs. 21.4 ± 2.7, p<0.001), postoperative cavernosograms confirmed that the paired corpora cavernosa are an ideal chamber for intracorporeal fluid retention in all patients, particularly; the penile crura displayed a stronger radiopacity than that of femoral cortex. There was 91.9% (168/183), 87.1% (81/93) and 91.2% (52/57) acceptable rate in the PC, PA and PI groups respectively while infection rate was 0.45% (3/668). Compare with the pain level of the penis and arm, there was significant in the VAS (19.5 ± 2.7 vs. 45.7 ± 4.6, p<0.001).
Conclusion: We may conclude, acupuncture assisted outpatient strategy was feasible for penile morphological and erectile function restoration basing on updated penile fibro-vascular anatomy.