Abstrait

Penile venous stripping surgery is a viable option for erectile dysfunction after unsuccessful vascular interventions

Cheng-Hsing Hsieh, Cheng-Wen Chen, Hung-Meng Huang, Hollis Johnson, Ru-Jeng Teng and Geng-Long Hsu*

To study whether penile venous stripping can improve erectile function after unsuccessful prior vascular interventions. Methods: This study is a retrospective review of the 49 consecutive patients that sought our assistance between 1999 and 2016 after receiving unsatisfactory vascular interventions elsewhere. Patients were evaluated by the abridged 5-item version of the International Index of Erectile Function (IIEF-5) and pharmaco-cavernosography. After the evaluation, the 36 patients without cardiovascular problems underwent a salvaging penile venous stripping and while the 13 remaining patients did not undergo the procedure. 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 reached. Finally, the wound was closed with 5-0 chromic sutures. Results: The follow-up period ranged between 1.0 and 16.5 years. Patients reported adequate and acceptable penile morphology postoperatively. Though there was no significant difference in IIEF-5 scores between the two groups preoperatively (n=13, 7.3 ± 1.9 vs. n=36, 7.6 ± 2.3, p=0.11), there was a statistically significant difference between treatment (n=36, 7.6 ± 2.1 vs. 17.4 ± 4.1, p<0.001) and control groups (n＝13, 5.9 ± 1.8 vs. n=29, 18.7 ± 3.4, p<0.001). Postoperative cavernosograms confirmed that the paired corpora cavernosa are an ideal chamber for intracorporeal fluid retention in all patients, particularly, the penile crura displayed a 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 from prior interventions. Conclusions: Penile venous stripping appears to be a viable option for those who have undergone unsatisfactory prior vascular interventions for erectile dysfunction.