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A Physiological Approach to a Penile Venous Stripping Surgical Procedure for Patients with Erectile Dysfunction

Geng-Long Hsu, Heng-Shuen Chen, Sheng-Jean Huang

Background: A refined penile venous stripping has been found effective in treating Erective Dysfunction (ED) for nearly three decades. It appears more viable chronologically while several modifications have been made. We sought to report on the most advanced method.
Materials and Methods: The study included 98 male patients treated from February 2003 to March 2006. All they were diagnosed with ED secondary to Veno-Occlusive Dysfunction (VOD) and were refractory to prior medical treatment. Among them 35, 32, and 31 men were allocated to the circumferential, semi-circumferential, and control group respectively. The two treatment groups received penile venous stripping via a circumferential or semicircumferential approach correspondingly, while the control group received only simple follow-up. After degloving the tissues superficial to Colles’ fascia, the confluent channel of the Deep Dorsal Vein (DDV) was identified. It was then clamped 2.0 cm proximal to the retrocoronal sulcus, and thoroughly stripped and ligated proximally and distally using 6-0 nylon sutures with a pull-through maneuver. The Cavernosal Veins (CVs) were managed with the same technique, while the Para-Arterial Veins (PAVs) were only segmentally ligated. A median longitudinal public incision was then made to resort the DDV and CVs stripped proximally till the infrapubic angle. Lastly, all wounds were fashioned layer by layer, while penile shaft was being stretched consistently by an assistant. Results: The operative times were 2.4 ± 0.2 and 3.1 ± 0.4 hours respectively for the circumferential and semicircumferential groups. The follow-up periods ranged 3.2-7.2 years with an average of 5.4 ± 1.3 years. The operative time, postoperative frenulum edema (3.2 ± 1.6 vs. 11.9 ± 2.1 days) and satisfaction rate of surgical course were significantly different (p<0.01) in favor of the circumferential approaches although no difference was noted in postoperative infection among two different approaches. Differences in erectile function were significant between the treatment groups and the control group in terms of preoperative IIEF-5 (9.8 ± 2.3 and 9.6 ± 2.1) scores compared to postoperative (21.6 ± 2.5 and 20.8 ± 2.7) ones respectively (both p<0.001) although no difference was found between the two surgical approaches. Overall, 51 patients in the treatment groups (51/67; 90.4%) reported significant improvement; whereas some worsening in IIEF-5 scores was noted in the control group during the same period of follow up time.
Conclusion: A circumferential along with median longitudinal pubic incision was found to be a viable physiological approach with favorable outcomes and negligible morbidity for treating ED secondary to VOD.