許耕榕^1,2,4、謝政興³、張宏江⁴、蔡培斌²、陳明村²

栩仕診所^1,2,4書田泌尿眼科診所²、泌尿部慈濟醫院³、台大醫院⁴

Geng-Long Hsu^1,2,4, 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.