血管內治療術適用於陰莖靜脈閉鎖不全的患者嗎
許耕榕1*、張宏江2、闕士傑2、謝政興3
栩仕診所、書田泌尿眼科診所1、台大醫院2、謝政興泌尿學診所3
Is endovascular venous intervention an option for treating patients with veno-occlusive dysfunction?
Geng-Long Hsu 1*, Hong-Chiang Chang2, Jeff SC Chueh2, Hsieh Cheng-Hsing3
1 Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology, Shu-Tien Urology Ophthalmology Clinic, Taipei, Taiwan
2 Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
3 Hsieh Cheng-Hsing Urology Clinic
Purpose: Given endovascular venous intervention is a viable strategy for treating varied venous diseases in the entire human body. On the A1 extraordinary blood flow of the penile veins, its righteousness might be questionable despite many latest publications recommending it as a minimally-invasively effective method in treating a man with veno-occlusive dysfunction (VOD). We report eight cases performed elsewhere internationally.
Materials and Methods: From 2013 to 2019, intractable erectile dysfunction prompted eight men to seek penile venous stripping surgery (PVSS) despite penile venous endovascular intervention for treating veno-occlusive dysfunction (VOD) internationally. Among them, four underwent endovascular sclerotherapy (ES), two with coil embolization (CE), and the remaining two underwent ES and CE. The age varied from 24 to 44; five patients are primary impotence, while the impotence occurred before 25 in the remaining three. All received chest X-rays, KUB, our dual cavernosography in which a pilot cavernosograpy showed the penile venous anatomy, PGE-1 test in-between, and a VOD was documented by pharmaco-cavernosography. In addition, two of them received MRI or CT-cavernosography and echocardiography, respectively. PVSS was conducted in all males, followed by postoperative cavernosography. PVSS entailed the venous stripping of one deep dorsal vein, and two cavernosal veins after every emissary's vein was fixed firmly closest to the outer tunica with a 6-0 nylon suture.
In contrast, the para-arterial veins were just segmentally ligated. To assess erection restoration, a radio-opacity was used to compare the femoral cortex and that of the penile crus on preoperative and postoperative cavernosography. In addition, 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. Postoperative follow-up is made via INTERNET yearly.
Results: The average follow-up period is 6.3±2.1 years. Inserted coils scattered along the deep dorsal veins (n=3), right pulmonary artery (n=2), periprostatic plexus (n=1), iliac vein (n=1), left pulmonary artery (n=1), and right ventricle (n=1) with cardiac wall perforation in one and half years. One patient declined a follow-up. There was a significant difference (n=7, P＜0.01) between the preoperative (7.0±2.1) vs. Postoperative IIEF-5 scores (15.9±3.2). The EHS improved at least one scale. The radiopacity was unexceptionally enhanced postoperatively. The four men who underwent ES reported a reduced 3 to 5 IIEF score internationally. The gratifying outcome ensued in two patients and one as long as 18 months postoperatively.