靜脈治療術後效果不彰再接受陰莖靜脈截除術患者之益處
許耕榕
栩仕診所男性功能重建中心、臺大醫學院泌尿部
Penile venous stripping surgery seems a viable option for treating erectile dysfunction evidenced by salvaging benefits in patients who underwent unsuccessful vascular interventions
Geng-Long Hsu
Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology and Department of Urology, National Taiwan University, Taipei, Taiwan
Purpose:
Erectile dysfunction is still a problem issue in which there is a paucity of nature cure. To explore whether penile venous stripping can enhance erectile function, we conduct a retrospective study on patients who underwent salvage penile venous stripping after unsuccessful vascular intervention performed elsewhere in recent decades.
Materials and Methods:
Between 1999 and 2016, 49 consecutive patients sought our assistance after receiving vascular interventions elsewhere. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) and pharmaco-cavernosography were used to evaluate the patients. Of them 36 men without cardiovascular problems underwent a salvaging penile venous stripping and the remaining 13 patients were free from this surgery. A circumferential incision was first made to strip the erection-related veins with 6-0 nylon sutures. A median longitudinal pubic incision was used to complete the stripping proximally until the infrapubic angle was encountered. Finally, the wound was fashioned with 5-0 chromic sutures. Along with preoperative imaging, postoperative cavernosography was routinely conducted for confirming sufficient venous stripping and comparison of radio opacity between the femoral cortex and the corpora cavernosa especially the penile crura.
Results:
The follow-up period ranged between 1.0 and 16.5 years. Patients reported unexceptionally acceptable penile morphology postoperatively. On erectile function, in term of IIEF-5 scoring although there was no significant difference between the two groups preoperative (n＝13, 7.3±1.9 vs. n=36, 7.6±2.3, p＞0.11), there was statistically significant between treatment (n=36, 7.6±2.1 vs. 17.4±4.1, p<0.001) and groups (n＝13, 5.9±1.8 vs. n=29, 17.7±3.4, p＜0.001). Postoperative cavernosograms categorically confirmed that the corpora cavernosa are an ideal chamber for intracorporeal fluid retention in all patients, particularly, the penile crura was unexceptionally stronger radiopaque than that of femoral cortex. Furthermore, we identified certain unexpected complications, such as embolization coils lodged in the cardiopulmonary avenues and electrocautery-induced fibrosis.
Conclusion:
Overall this penile venous stripping appears to be a viable option for those who have undergone prior vascular interventions.