Hsu Geng-Long, Molodysky Eugen, Liu Shih-Ping, Chang Hong-Chiang, Hsieh Cheng-Hsing, Hsu Chih-Yuan
Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology and Puli Christian Hospital, Nanto, Taipei, Taiwan ; Department of Urology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
Discipline of General Practice, Sydney School of Medicine, University of Sydney, Australia.
Arab J Urol. 2013 Dec;11(4):375-83. doi: 10.1016/j.aju.2013.08.009. Epub 2013 Sep 17.
To report an innovative combination of two surgical procedures to treat patients with erectile dysfunction and penile deviation, arising from advances in penile anatomy.
From October 1998 to October 2011, 132 men (aged 23-39 years) underwent penile venous stripping and corporoplasty. Of these, 37 were allocated to a transverse and 95 to a longitudinal group, with an infrapubic transverse or pubic median longitudinal approach, respectively. The abridged five-item version of the International Index of Erectile Function (IIEF-5) and cavernosography were used for assessment, as necessary. Under acupuncture-aided local anaesthesia, and after a circumferential incision, the deep dorsal vein and cavernous veins were completely stripped, with 6-0 Nylon sutures for ligation, followed by tunical surgery for correcting the penile shape.
In the transverse and longitudinal groups the mean (SD) duration of surgery was 4.6 (0.2) and 4.8 (0.3) h, respectively. Before surgery the mean (SD) IIEF-5 score was 9.4 (2.3) and 9.6 (2.1), which increased to 20.6 (2.4) and 20.8 (2.7), respectively, after surgery. The penile shape (<15°) was deemed satisfactory in 92% (34/37) and 96% (91/95) of patients in the transverse and longitudinal groups, respectively. The cavernosograms consistently showed a good penile shape. There were significant differences in the mean (SD) duration of penile oedema, at 3.2 (1.6) vs. 11.9 (2.1) days, the overall satisfaction rate and the prevalence of hypertrophied scarring (all P < 0.001).
This combination of unique penile venous stripping with a pubic median longitudinal approach and an anatomy-based corporoplasty is ideally suited to the simultaneous restoration of penile erectile function and morphological reconstruction.
报告一种创新的联合手术方法，用于治疗因阴茎解剖学进展而导致勃起功能障碍和阴茎弯曲的患者。
1998年10月至2011年10月，132名年龄在23至39岁之间的男性接受了阴茎静脉剥脱术和海绵体成形术。其中，37例采用耻骨下横向入路，95例采用耻骨正中纵向入路，分别归入横向组和纵向组。必要时使用国际勃起功能指数（IIEF-5）简版五项问卷和海绵体造影进行评估。在针刺辅助局部麻醉下，经环形切口后，将阴茎背深静脉和海绵体静脉完全剥脱，用6-0尼龙缝线结扎，随后进行白膜手术以矫正阴茎形状。
横向组和纵向组的平均（标准差）手术时间分别为4.6（0.2）小时和4.8（0.3）小时。术前IIEF-5平均（标准差）评分为9.4（2.3）和9.6（2.1），术后分别增至20.6（2.4）和20.8（2.7）。横向组和纵向组分别有92%（34/37）和96%（91/95）的患者阴茎形状（<15°）被认为满意。海绵体造影始终显示阴茎形状良好。阴茎水肿的平均（标准差）持续时间存在显著差异，分别为3.2（1.6）天和11.9（2.1）天，总体满意率和肥厚性瘢痕发生率也存在显著差异（均P<0.001）。
这种独特的阴茎静脉剥脱术与耻骨正中纵向入路及基于解剖学的海绵体成形术相结合，非常适合同时恢复阴茎勃起功能和形态重建。
