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

Abstract

Introduction The common surgery for venous leakage was not very successful; unsatisfactory long-term results have reduced the indications for venous surgery for erectile dysfunction (ED). Aims To assess the outcomes of embedding the deep dorsal vein of the penis (EDDVP), a new surgical technique used in patients with penile deep dorsal venous leakage of ED. Methods Between December 2001 and November 2007, 17 patients diagnosed with penile deep dorsal venous leakage of ED underwent embedding the deep dorsal vein of the penis. Main Outcome Measures All cases were available for follow up by using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) scoring system and penile color Doppler ultrasound. Dynamic cavernosography were also assessed in three patients at 3 months postoperatively. Results After surgery, 14 patients were able to achieve satisfactory intercourse and three had sufficient erection after oral sildenafil (50–100 mg). The IIEF-5 scoring changed from a preoperative mean IIEF-5 score of 8.8 ± 3.9 to 20.8 ± 4.1 (P < 0.05). Peak systolic velocity (average of right and left cavernosal arteries) changed from 41.9 ± 7.7 cm/second to 44.2 ± 9.2 cm/second (P > 0.05), resistance index changed from 0.79 ± 0.1 to 1.00 ± 0.0 (P < 0.05), and venous velocity changed from 8.4 ± 4.0 cm/second to 0.0 ± 0.0 cm/second (P < 0.05). Dynamic cavernosography demonstrated a smooth flow of the deep dorsal vein during the flaccid phase. During the tumescent phase, the deep dorsal vein of the penis was compressed between the dilated sinusoidal spaces and the tunica albuginea and resulted in venous drainage blockade. And then the hardness of erection was improved and maintained. Conclusions The new surgical technique of EDDVP is a simple operative procedure, which seems to be efficient in the treatment of penile deep dorsal venous leakage of ED.

Dynamic infusion cavernosometry and cavernosography for classifying venous erectile dysfunction and its significance for individual treatment

“…In the tissue biopsy of albuginea under microscope, collagen fiber atrophy was observed. [17] Zhang et al [18] reported that the surgery of embedding deep dorsal vein of penis had achieved good effects for treatment of vein leakage ED, and 14 out of 17 patients obtained satisfying effects. Popken G reported that 122 patients who had received ligation of deep dorsal vein of penis with a total effective rate of 33%.…”

Erectile dysfunction and caverno-venous leak disease

“…In a further study from Chen a highly significant change in IIEF score after long-term observation was stated for patients who underwent deep dorsal vein stripping [33]. Very recently Zang reported about very good long-term success rates after deep dorsal vein embedding (100%), respectively [34].…”

Morphological study of the valve apparatus superficial venous system of the human penis

“…Поскольку ГДВ наиболее часто становится путем патологического оттока крови от кавернозных тел при веногенной эректильной дисфункции, она считается и основным объектом хирургического вмешательства. Осуществляют ее лигирование, иссечение, склерозирование [7], погружение в дупликатуру белочной оболочки [8]. Проводят также склерозирование путей оттока от нее -вен простатического сплетения, внутренних и наружных половых вен [9,10].…”

“…В связи с этим ре дукционные хирургические вмешательства на венах полового члена не относятся к рекомендованным и не входят в стандарт лечения эректильной дисфункции [13][14][15]. Высокую эффективность, превышающую 75 % в отдаленные сроки, демонстрируют лишь отдельные клиники -приверженцы венозной хирургии -у небольшого числа пациентов, причем преимущественно молодых [8,16]. Причинами неудовлетворительных результатов считают, во-первых, то, что лечение веногенной эректильной дисфункции путем прекращения кровотока по венам не является патогенетическим, а во-вторых, то, что венозная редукция при отсутствии точной топической диагностики венозной утечки с большой вероятностью не будет радикальной [17,18].…”