Advancement of a physiologically therapeutic strategy in managing young patients with erectile dysfunction
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: Young male does not always possess normal erectile function particularly in those who suffer from a psychological disturbance. We report a breakthrough method - physiological erection restoration on patients who were under 40.
Material and method: From 2010 to 2020, 163 out of 275 patients whose diagnosis with venogenic erectile dysfunction (ED) under the age of 40 received a physiologically penile venous stripping for restoring erectile function despite each were having been diagnosed elsewhere with psychologically-induced ED. The stripping procedure included a deep dorsal vein and a pair of cavernosal veins while their emissary's veins were firmly ligated closest to the outer tunica albuginea with 6-0 nylon suture; whereas the two pairs of para-arterial veins were only segmentally ligated. Among these patients, 37 and 126 were categorized into the adolescent and adult groups meanwhile 25 and 98 males of no surgery as control groups respectively, based on whether ED onset occurred during adolescence or adulthood. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and corporeal radio-opacity were used to assess erection restoration. Additionally, the erection hardness scale (EHS) was used for confirmation of improvement.
Results: In both groups, there was a significant difference (both P＜0.0001) between the pre-operative (9.6±3.4 vs. 9.9±3.7) vs. post-operative IIEF-5 scores (19.8±4.3 vs. 20.1±4.1); in treatment, however, there was no significant difference (p>0.8) between the adolescent and adult groups. The pre-operative radiopacity of the penile crus was, without exception, post-operatively enhanced and became stronger than that of the femoral cortex in 93.2% (157/163) patients. In the adolescent group, 89.7% (33/37) patients had suicidal thoughts and 79.3% (29/37) underwent psychiatric management; unfortunately, this intervention did nothing to resolve their ED. Overall, the improved rate is 91.7% (149/163), and all reported improvements on the EHS.
Conclusion: It appears that physiologically penile venous stripping is the most feasible option in managing young males particularly in adolescents with ED.