Hsu Geng-Long, Chen Heng-Shuen, Hsieh Cheng-Hsing, Lee Wen-Yuan, Chen Kuo-Liang, Chang Chao-Hsiang
Microsurgical Potency Reconstruction and Research Center, Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
J Androl. 2010 May-Jun;31(3):250-60. doi: 10.2164/jandrol.109.008409. Epub 2009 Sep 10.
Disappointing functional outcome and penile deformity are major concerns of penile venous surgery. Consequently, it has been abandoned by most urologists. To explore whether penile deformity is correctable and erectile function can be improved, we report our experience in patients who had undergone surgery elsewhere. From 1986 to 2008, 16 consecutive patients sought our assistance because of poorer erectile capability or/and penile deformity from previous venous surgery elsewhere. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) was used to score the patients when it became available in 1998. Accordingly, 3 and 13 patients were categorized into the non-IIEF and IIEF groups, respectively. A median longitudinal pubic incision and a circumferential or semicircumcision were made to relieve the fibrotic tissues for accessing the deep dorsal veins, which were stripped thoroughly and ligated with 6-0 nylon sutures. The cavernosal veins were managed in a similar manner. The paraarterial veins were ligated only segmentally. Finally, the wound was approximated while an assistant consistently stretched the penile shaft. The operation time was 5.2 to 8.5 hours. The follow-up period ranged from 0.6 to 23.0 years. Overall, all patients reported satisfactory penile morphology postoperatively. In the IIEF group, the difference in preoperative and postoperative scores was significant (P < .001). In the non-IIEF group, 2 of the 3 patients reported natural coitus. This series of salvaging venous surgeries, although technically challenging, are helpful in correcting penile deformity and restoring erectile function in some patients who had poorer outcomes from prior venous surgeries.
阴茎静脉手术令人失望的功能结果和阴茎畸形是主要关注点。因此，大多数泌尿外科医生已不再采用该手术。为探讨阴茎畸形是否可矫正以及勃起功能能否改善，我们报告了对曾在其他地方接受过手术的患者的治疗经验。1986年至2008年，16例连续患者因先前在其他地方进行的静脉手术导致勃起功能较差或/和阴茎畸形而寻求我们的帮助。1998年国际勃起功能指数（IIEF - 5）简版5项问卷可用后，我们用其对患者进行评分。据此，分别有3例和13例患者被归入非IIEF组和IIEF组。做一个耻骨正中纵向切口和一个环形或半环形包皮环切术，以松解纤维化组织，便于显露深背静脉，将其彻底剥离并用6 - 0尼龙缝线结扎。海绵体静脉的处理方式类似。动脉旁静脉仅分段结扎。最后，在助手持续牵拉阴茎体时缝合伤口。手术时间为5.2至8.5小时。随访时间为0.6至23.0年。总体而言，所有患者术后阴茎形态均令人满意。在IIEF组，术前和术后评分差异有统计学意义（P < .001）。在非IIEF组，3例患者中有2例报告能进行自然性交。这一系列挽救性静脉手术虽然技术上具有挑战性，但有助于矫正阴茎畸形并恢复一些先前静脉手术效果较差患者的勃起功能。
