Shaeer Osama, El-Shaarawy Ehab A A, Emam Hossam Y, Elsisi Islam, Sokar Eslam, Shaeer Kamal
Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt.
The Middle East Society for Sexual Medicine, Cairo, Egypt.
Int J Impot Res. 2024 Feb 29. doi: 10.1038/s41443-024-00846-1.
Vein ligation for veno-occlusive erectile dysfunction is being abandoned due to the recurrence rate. Among the reasons for failure is inability to ligate the deep system of veins; the internal pudendal vein. The vein exits the pelvis in the gluteal region, from the lesser sciatic foramen to the greater sciatic foramen, coursing over the ischial spine and sacro-spinous ligament, under the gluteus maximus. This work aims to verify feasibility of the first surgical procedure to ligate the internal pudendal vein through the gluteal approach. This cadaveric study involved five formalin-fixed cadavers. A surface anatomical landmark was designed to identify the ischial spine, at the intersection of two lines: a vertical line from posterior superior iliac spine to ischial tuberosity, and a horizontal line extending from sacro-coccygeal joint, laterally. An incision is cut encompassing the target point. Subcutaneous fat is dissected down to the gluteus maximus, which is split along the direction of its fibers. The vein can be found crossing over the ischial spine. "Shaeer's Vein Ligation - I" appears to be surgically feasible. A protocol for a surgical study is registered at clinicaltrials.gov, and is open for participation.
由于复发率高，静脉结扎术治疗静脉闭塞性勃起功能障碍正逐渐被摒弃。失败原因之一是无法结扎静脉深部系统，即阴部内静脉。该静脉在臀区从骨盆穿出，经坐骨小孔至坐骨大孔，跨过坐骨棘和骶棘韧带，走行于臀大肌下方。本研究旨在验证经臀入路结扎阴部内静脉的首例手术的可行性。本尸体研究涉及5具用福尔马林固定的尸体。设计了一个体表解剖标志来确定坐骨棘，位于两条线的交点处：一条从髂后上棘到坐骨结节的垂直线，另一条从骶尾关节向外延伸的水平线。在包含目标点的位置做一个切口。切开皮下脂肪直至臀大肌，沿其纤维方向劈开臀大肌。可发现该静脉跨过坐骨棘。“Shaeer静脉结扎术-I”在手术上似乎是可行的。一项手术研究方案已在clinicaltrials.gov上注册，并开放参与。
