陰莖靜脈截除術應用在達文西攝護腺根除術致痿之患者

許耕榕 ¹、鍾卓興²、陳明村 ³、殷約翰 ³、謝宜穎 ⁴、闕士傑 ⁴

¹ 埔里基教醫院 顯微男性功能重建暨研究中心 ; ²臺北醫學大學萬芳醫院泌科；³書田泌尿科眼科診所; ⁴臺灣大學附設醫院泌尿部

Penile venous stripping for patients with impotence secondary to da Vinci prostatectomy for prostate cancer

Geng-Long Hsu^1.2.3, Cho-Hsing Chung⁴, Ming-Tsun Chen², Jue-Hawn Yin², Yi-Ying Hsieh³, Jeff SC Chueh³

1 Puli Christian Hospital, Microsurgical Potency Reconstruction and Research Center, Puli

Township, Nantou, Taiwan

² Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology and Shu-Tien

Urology Ophthalmology Clinic, Taipei, Taiwan

³ Department of Urology, National Taiwan University Hospital, Taipei 10002, Taiwan

⁴ Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

Purpose: Currently, da Vinci prostatectomy (dVP) is the treatment of choice for the surgical options for non-advanced prostate cancer; unfortunately, erectile dysfunction (ED) is likely unavoidable. Physiological penile venous stripping (PVSS), based on penile fibro-vascular assembly, appears to be an option for erection restoration. We sought to report PVSS to patients who sustained ED secondary to dVP, as only evidence can speak volumes and practice is the exclusive criterion for testing the truth, so do this promising surgical practice.  

Materials and Methods: From 2011 to 2024, 15 patients requested PVS to treat ED resulting from radical prostatectomy. All claimed acceptable erections before radical prostatectomy. Veno-occlusive dysfunction (VOD) was confirmed by dual cavernosography unexceptionally. Among them, eight patients underwent dVP, and those who underwent PVS were allocated to the surgery group (n=5), whereas the remaining were controls (n=3). Ambulatory PVSS was performed using acupuncture-assisted local anesthesia, with the acupoints He-gu (LI4), Shou San Li (LI10), and Wai-guan (TE5) selected. PVSS began with a circumferential approach. Then, PVS was made circumferentially, entailed one deep dorsal vein and two cavernosal veins after each emissary vein was firmly fixed closest to the outer tunica using 6-0 nylon. Subsequently, segmental ligation was performed on para-arterial veins, which will be engorged within quarters. Comparison of penile crural opacity was made preoperatively and postoperatively. The Erection Hardness Scale (EHS) and the abridged 5-item version of the International Index of Erectile Function (IIEF-5) were used preoperatively, postoperatively, and at follow-ups.

Results: The follow-up period was 5.2±0.8 years. Surgery time was 377.7±29.9 minutes, and blood loss was negligible. The ligation numbers are 29-35 from the retrocoronal sulcus to the confluent channel of the DDV and 95-109 ligatures proximally. There was a significant improvement after surgery [(both P≤0.01 in IIEF-5 and EHS scores (16.8±2.3 vs. 4.7±0.6; 2.2±0.6 vs. 0.7±0.3, respectively)]. The radio-opacity of the penile crura indicates the intracorporeal retention, which confirms the corpora cavernosa being free from leakage. Furthermore, the glans dimension increased significantly from 35.3±2.2 mm to 36.3±2.1 mm. An ideal penile morphology was additionally performed in one patient to correct a 60-degree dorsal curvature.

Conclusion: This emergent PVSS is not above controversy; nevertheless, as a sexual practitioner, it is challenging to decline this dVP-induced ED patient secondary to VOD. PVSS appears to be an option for them, though, given the extreme sample size, further study is warranted.