#1442

Physiological Approach for penile venous stripping and varicocelectomy

Geng-Long Hsu¹, Chung-Cheng Lin², Heng-Shuen Chen³, Yi-YIng Hsieh⁴

¹ Puli Christian Hospital, Microsurgical Potency Reconstruction and Research Center,, Puli,
² Puli Christian Hospital, Department of Urology, Puli,
³ Puli Christian Hospital, Microsurgical Potency Reconstruction and Research Center, Puli,
⁴ National Taiwan University Hospital, Department of Urology, Taipei

Introduction:
Varicocele may be the most common disease entity in urology. Although varicocelectomy, the ligation of the internal spermatic vein (LISV), was incepted for a century and advanced to minimally invasive surgery, whether the conventional open method is contentious. Meanwhile, penile venous stripping surgery (PVSS) is cautious despite notable evidence. We conduct a retrospective study and report a single approach to materialize PVSS and LISV with acupuncture-aided local anesthesia on an ambulatory basis to fill the research gap.

Materials and Methods:
From May 2018 to October 2024, 33 patients, aged 29 to 57 years, consulted our institute, addressing PVSS and LISV to treat veno-occlusive dysfunction (VOD) and worm-like scrotal tuft. All received dual cavernosography, and veno-occlusive dysfunction (VOD) was confirmed in 90.0% (31/33), whereas the opacification was 100% (33/33). Routinely, the acupoints of Hegu (LI4), Shou San Li (LI10), and Waiguan (TE5) are chosen. Using 0.8% lidocaine with epinephrine rinsed standard saline solution, dorsal nerve block, crural block, and peri-penile infiltration was performed, then a 3.5-4.0 Cm pubic longitudinal was made. Then, an inside-out maneuver was made. PVSS was made from the retro coronal sulcus to infra-pubic angle, with ligatures of every emissary vein of erection-related veins, composed of a deep dorsal vein (DDV), a pair of cavernosal veins (CVs), and two pairs of para-arterial veins closest to the outer tunica albuginea using 6-0 nylon sutures. After bilateral cord block, LISV was meticulously done without bleeding risk. The wound was fashioned using 6-0 nylon layer by layer. The ligation number, surgery time, and blood loss were recorded During surgery. Postoperative cavernosography was routinely conducted. With. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) and the Erection Hardness Scale (EHS) were used preoperatively and postoperatively yearly during follow-up.

Results:
The follow-up period was 3.2±0.8 years. Surgery time was 137.7±29.9 minutes, and blood loss was minimal. The ligation numbers are 29-35 from retrocoronal sulcus to confluent channel of the DDV and 95-109 ligatures proximally. The venous channels account for 10-12 of the internal spermatic veins. There was a significant improvement (both P＜ 0.01) in IIEF-5 and EHS scores (9.8±2.6 vs. 21.3±2.2; 1.8±0.5vs. 3.3±0., respectively). The erection-related veins were much more intriguing than illustrated conventionally. Meanwhile, the venous drainage channels are more numerous than that illustrated traditionally. Neither an electrocautery nor suction apparatus is required for all procedures. All patients are uneventful; 21.2% (7/33) flew across the ocean in two days.