Insufficient Response to Venous Stripping Surgery: Is the Penile Vein Recurrent or Residual?

Abstract

There is currently controversy on whether the insufficient response to penile venous surgery done in an attempt to restore erectile function is due to recurrent or residual veins. In order to elucidate this issue, we report a study on those patients who failed to respond to the first venous surgery and subsequently underwent or declined a second operation. From July 1996 to July 2003, a total of 83 patients, aged 25 to 83, who were dissatisfied with their first venous surgery and were later diagnosed with a persistent veno-occlusive dysfunction via our dual cavernosography, were recruited into our study. Subsequently, 45 men underwent penile venous stripping surgery for a second time and were assigned to the surgery group, whereas the remaining 38 men were subject to followup and routine management and were assigned to the control group. All were evaluated with the abridged 5-item version of the international index of erectile function (IIEF-5) every 6 months for 1 to 5 years and cavernosogram, if necessary. In the surgery group their preoperative IIEF-5 score was 10.1 6 3.7, which increased to 17.1 6 3.2 (P , .001) after the first surgery and further increased to 20.7 6 3.1 (P , .001) after a second venous stripping of the cavernosal vein that was consistently demonstrated on the cavernosogram. Overall, 41 men (91.1%) reported a positive response to further venous surgery, with more satisfactory coitus, after the residual veins were stripped thoroughly, although eventually 4, 3, and 3 men required additional oral sildenafil, penile implant, and intracavernosal injection, respectively. The follow-up period ranged from 12 months to 72 months, with an average of 37.0 6 11.5 months. In the control group, however, their corresponding IIEF-5 score changed from 17.4 6 2.9 to 16.9 6 3.2 (P . .05). Finally, 11, 7, and 8 men required additional oral sildenafil, penile implant, and intracavernosal injection, respectively. Although there was no statistical significance between the 2 groups in the first postoperative IIEF-5 scores, there was a significant difference in their IIEF-5 after further venous surgery. In this study, we propose that the clinical relapse of erectile dysfunction is a result of ''residual'' veins rather than ''recurrent'' ones. (Wespes et al, 1985;Bennett et al, 1986). The approach was extended from initial procedures involving singlevessel ligation of the deep dorsal vein to more elaborate techniques in which excision of the deep dorsal vein, cavernous vein, and crural vein were described (PuechLeao et al, 1987;Lewis, 1988;Lue, 1989). Current theories, however, seem to ascribe the veno-occlusive dysfunction (VOD) to a defect within the penis rather than the veins themselves (Wespes et al, 1993) and suggest that the major contributor of erectile dysfunction is corporeal fibrosis due to an abnormality in the regulation of collagen synthesis and suggest degradation as the most likely etiology, secondary to chronic ischemia (Nehra et al, 1996). Thereafter, venous surgery per se, regardless of ...

Surgical niche for the treatment of erectile dysfunction

“…127 Furthermore, Hsu inferred that clinically relapsed ED occurred in patients receiving prior venous surgery as a sequela of residual rather than recurrent veins of the penis. 128 Wen et al proposed a remedy for CVOD through the synergistic effects exerted by venous surgery and medication with oral sildenafil. 129 For the treatment of ED, a summary of evaluations appraising penile venous surgery is adapted in Table 3.…”

“…As for patients experiencing declined capability of erection attributable to prior venous surgeries, whether penile deformity was present or not, salvaging penile venous stripping surgery has been reported to give modest results as well . Furthermore, Hsu inferred that clinically relapsed ED occurred in patients receiving prior venous surgery as a sequela of residual rather than recurrent veins of the penis . Wen et al.…”

physiology: Clinical implications for physicians and surgeons

“…Might we not infer then that a fully rigid erection may depend upon the drainage veins as well, rather than just on the intracavernosal smooth muscle? Therefore, might we not look at venous malfunction [49,50] – a phenomenon manifest in a variety of other disease entities, including hemorrhoids [51], varicose veins of the leg [52], and varicocele testis [53] – with a renewed appreciation for its critical role in ED? It is understandable that veins are susceptible to dysfunction in dependent portions in upright animals, implying that these various diseases could, to a large extent, be avoided if man walked on 4 feet.…”

Treatment of Penile Deep Dorsal Venous Leakage of Erectile Dysfunction by Embedding the Deep Dorsal Vein of the Penis: A Single Center Experience with 17 Patients

“…Venogenic ED (VED) may be caused by the formation of large venous channels draining the corpora cavernosa, degenerative changes to the tunica albuginea, structural alterations of the cavernous smooth muscle and endothelium [2][3][4][5][6][7][8][9][10][11][12][13]. Whatever the cause, the main goal of treatment is to occlude this venous outflow [8][9][10][14][15][16][17]. The site of venous leakage from the penis identified as the deep dorsal vein was visualized in 77.5% [1].…”