用螺圈栓塞靜脈治療陰莖靜脈閉鎖不全的患者合理嗎

許耕榕^1,2,*、張宏江³、謝政興⁴、

栩仕診所^1,2書田泌尿眼科診所²、台大醫院³、泌尿部慈濟醫院⁴

Is coiled embolization justified for treating patient with veno-occlusive dysfunction: a case report and systemic review?

Geng-Long Hsu^1,2, Hong-Chiang Chang³, Cheng-Hsing Hsieh⁴

¹ Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology, Shu-Tien Urology Ophthalmology Clinic and Chung Shan Hospital², Taipei, Taiwan

³ Department of Urology, National Taiwan University hospital, Taipei, Taiwan

⁴ Hsieh Cheng-Hsing Urology Clinic

ABSTRACT

Purpose:

Given coil embolization is a viable option for treating varied vascular diseases in the entire human body. On the A1 extraordinary blood flow of penile veins, its suitability might be questionable despite many latest publications recommend it as a minimally-invasively effective method in treating man with erectile dysfunction. We report six cases and a systemic review of this issue.

Materials and Methods:

From 2013 to 2019, refractory impotence prompted 6 men to seek our penile venous stripping surgery despite penile venous embolization was performed for treating veno-occlusive dysfunction (VOD) internationally. All received chest X-ray, KUB, our dual cavernosogray in which the penile venous anatomy was shown by a pilot cavernosograpy, PGE-1 test in-between, and a VOD was documented by pharmaco-cavernosography. Two of them received MRI or CT-avernosography and echocardiography respectively. Penile venous stripping (PVS) was made in all patients followed by postoperative cavernosography. PVS 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 tunical level with 6-0 nylon suture, whereas the para-arterial veins were just segmentally ligated. To assess erection restoration, a radio-opacity was used for comparison between the femoral cortex and that of 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 for confirmation of improvement preoperative and postoperative follow-up via INTERNET yearly. Using PubMed, a systemic review was made on whether the efficacy of the coil embolization on patients with VOD if the patient sample size is more than 21 cases. 

Results:

The average follow-up period is 6.3±2.1 years. Inserted coils scattered along the deep dorsal veins (n=3), periprostatic plexus (n=1), iliac vein (n=1), right pulmonary artery (n=2), left pulmonary artery (n=1), and right ventricle (n=1) with cardiac wall perforation in one and half years. The radiopacity was exceptionally enhanced postoperatively. There was a significant difference (P＜0.01) between the pre-operative (9.6±2.7) vs. Post-operative IIEF-5 scores (18.8±4.3). The EHS improved at least one scale.  On coil venous embolization publication for treating VOD, six articles recommend it highly, whereas two regarded it as an acceptable option. All claimed it as a very minimally-invasively effective one.  

Conclusion:

It appears that the long-term efficacy of penile venous embolization is not beyond controversy, and its safety may be concerned and the term minimally invasive is not sustainable.