治療先前已接受過血管介入式治療的勃起功能障礙病人
謝政興1、許耕榕2,3、陳世乾3、許智源2
1慈濟大學醫學院 台北慈濟醫院 泌尿科；2栩仕診所 顯微手術功能重建暨研究中心；3台大醫院 泌尿部； 台北 台灣
Management of erectile dysfunction in patients who failed prior vascular intervention
Cheng-Hsing Hsieh1, Geng-Long Hsu2,3, Shyh-Chyan Chen3 and Chih-Yuan Hsu2
Division of Urology1, Taipei Tzu Chi Hospital, The Buddhist Tzuchi Medical Foundation; School of Medicine, Buddhist Tzu-Chi University, Hualien; Microsurgical Potency Reconstruction and Research Center2, Hsu’s Andrology, Taipei; Department of Urology3, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan
Purpose:
Varied penile vascular interventions are still controversial and commonly regarded as experimental settings. Disappointing outcome and penile dysmorphology are major concerns along with other complications. To explode whether our penile venous stripping can salvage other methods of vascular treatment, we report our experience.
Materials and Methods:
From 2010 to 2014, 11consecutive patients sought our assistance owing to disappointing prior vascular interventions elsewhere. The abridged five-item version of the International Index of Erectile Function (IIEF-5) was used to score the patients. A circumferential incision was first made to access the deep dorsal veins and cavernosal veins which were stripped thoroughly and ligated with 6-0 nylon sutures. A median longitudinal pubic incision was used to complete the stripping proximally and the para-arterial veins were just ligated segmentally. Finally the wound was fashioned layer by layer with 5-0 chromic suture.
Results:
The operation time was from 4.0 to 8.5 hours. The follow-up period ranged from 0.6-4.0 years. Overall all patients reported satisfactory penile morphology postoperatively while the preoperative and postoperative IIEF-5 scores was significant difference (8.8 ± 2.6 vs.16.6 ± 2.8, P < 0.001).
Conclusions:
This series of salvaging venous surgeries, though technically challenging, was exclusively beneficial and appeared a viable option to patients who had undergone prior vascular interventions.