創新的陰莖加大與勃起功能再造術

許耕榕¹、張宏江²、張毅凱²、謝政興³、闕士傑²

栩仕診所¹、台大醫院²、謝政興泌尿科診所³

An Innovative Combination of Penile Corporeal

Girth Enhancement and Erection Restoration

Geng-Long Hsu^1,*, Hong-Chiang Chang², Yi-Kai Chang², Cheng-Hsing Hsieh³, Shih Chieh Jeff Chueh²

¹ Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology, Taipei, Taiwan

² Department of Urology, National Taiwan University Hospital, Taipei, Taiwan

³ Cheng-Hsing Hsieh Urology Clinic

Purpose: It has been controversial in a penile reconstructive strategy for erection restoration conspicuously for a factual girth enhancement thus far. Based on the De Novo penile fibro-vascular assembly, we report an anatomy-physiology-based, innovative method of combining a physiological penile corporeal girth enhancement and erection restoration on an ambulatory basis in recent five years.

Materials and Methods: From 2016 to 2022, refractory impotence and subjective micropenis prompted 23 men to seek penile venous stripping surgery (PVSS) and factual penile enhancement (TPE). All patients received dual cavernosography in which the penile venous anatomy was shown by a pilot cavernosograpy, PGE-1 test in-between, and a venous leakage was documented by pharmaco-cavernosography. PVSS entailed the venous stripping of one deep dorsal vein and a pair of cavernosal veins after every emissary's vein was fixed firmly at the tunic level with a 6-0 nylon suture. In contrast, the para-arterial veins were just segmentally ligated. In conducting TPE, a longitudinal incision was performed over 3 and 9 O’clock positions of the pendulous penis bilaterally. Two tunic defects were water-tight sutures with a spliced 7x3 cm rectangle venous stripe and covered with Surgiform as the outer layer bilaterally, respectively. To assess the penile girth and glans penis, diameter measurement in cm was obtained preoperatively and postoperatively in six months when a cavernosogray was conducted. To consider erection restoration, a radio-opacity was used to compare the femoral cortex and the penile crus on preoperative and postoperative cavernosography. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) was used to confirm improvement in preoperative and postoperative follow-up via INTERNET yearly.

Results: The average follow-up period is 3.3±0.8 years. The radiopacity was unexceptionally enhanced postoperatively. There was a significant difference (P＜0.01) between the pre-operative (9.7±2.8) vs. Post-operative IIEF-5 scores (20.8±2.3). The EHS improved at least one scale.  The diameter of the glans and distal penile shaft is increased from 2.98±0.33 cm and 3.41±0.41 cm (n=18) to 2.88±0.32 cm and 3.49±0.31 cm, respectively. Although the satisfaction rate is only 72.2% (13/18), the intracorporeal retention and erection quality improvement were unexceptional.

Conclusion: This novel combination strategy of the factorial penile enhancement and erection restoration is feasible, although it requires a more significant sample size and surgery technology is challenging.