以創新解剖學為基礎的陰莖靜脈截除術對於靜脈閉鎖障礙患者的療效分析
許耕榕
栩仕診所男性功能重建中心、臺大醫學院泌尿部
Analysis of an anatomy-based physiology penile venous stripping method for patients with erectile dysfunction resulting from veno-occlusive dysfunction
Geng-Long Hsu
Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology and Department of Urology, National Taiwan University, Taipei, Taiwan
Purpose:
A refined penile venous stripping surgery has been a viable option for treating erectile dysfunction (ED) secondary to veno-occlusive dysfunction (VOD) in our practice in the past two decades. We carry out a retrospective analysis to ED patients who received the latest method of surgery under an acupuncture-aided pure local anesthesia on true outpatient basis.
Materials and Methods:
From March 2009 to December 2015, 452 patients, who were sexually inadequate and refractory to medical treatment, had a diagnosis of ED secondary to VOD. Of these, 383 men underwent the latest method of penile venous stripping. Using the borderline age of 30 years, they were divided into young (n=46) and older (n=237) group respectively. The surgery begins with a circumferential incision followed by degloving the preputial tissues superficial to Colles’ fascia, the confluent channel of the deep dorsal veins (DDV) was identified and enhanced by squeezing the corpora cavernosa 1.5~2.5 cm proximal to the retrocoronal sulcus. It was then thoroughly stripped and ligated with 6-0 nylon sutures with a pull-through maneuver. The cavernosal veins (CVs) were managed in a similar manner. The para-arterial veins (PAVs) were only segmentally ligated. A median longitudinal pubic incision was then made to relay the stripping of the DDVs and CVs proximally to the infrapubic angle. Finally the pubic and circumferential wounds were approximated layer by layer while an assistant consistently stretched the penile shaft. A postoperative cavernosograhy was made immediately. Subsequently a radiopacity comparison was made between the preoperative and postoperative ones on the corpora cavernosa especially the penile crura and the femoral cortex.
Results:
The operative times were 4.1 ± 0.7 and 4.0 ± 0.7 h respectively. The follow-up period ranged 1.2~7.2 years with an average of 5.3 ± 1.2 years. Differences in erectile function were significant between the groups of young and older group in term of preoperative IIEF-5 (n=14, 10.2 ± 3.6 and n=237, 9.7 ±3.8) scores compared to either one year postoperative (n= 46, 19.1 ± 3.2 and n=237, 16.4 ± 3.0) ones or two years postoperative (21.3± 1.7 and 18.2 ± 3.2) respectively (both p<0.003). Overall, 92.3% (261/283) of the patients reported improvements. Regarding the comparison between the preoperative and postoperative cavernosograms, it was unexceptionally enhanced from weaker to stronger radiopaque by this penile venous stripping.
Conclusion:
This latest method of penile venous stripping appears to be a viable option which achieves favorable outcomes with negligible morbidity for treating ED secondary to VOD.