(152) Efficiency Improvement Veno-Occlusive Surgeries for Treatment of Venous Leak with Autologous Stem Cell, VEGF and PRP

Abstract

Abstract Introduction The venous leakage is one of the most often reason of erectile dysfunction (ED) in young and middle age men. The main reason of venous leakage or veno-occlusive Erectile Dysfunction (VOED) is the insufficiency venous obstruction under tunica albuginea of corpora cavernosa. Accordingly all types of veno-occlusive operations have particular and short term effect up to renovation of venous leakage in half year. Conservative treatment of VOED with PDE-5 has a low or mild effectiveness. Evermore young patients deny penile prosthesis implantation for psychological reason. Objective We want to stimulate growth of endothelial valves under tunica albuginea with injections autological mesenchymal stem cells (ASC) and autological VEGF (Vascular endothelial growth factor) and combine it with veno-occlusive surgeries. Methods 2012–2022 we treated 178 patients with VOED. The average patient age is 36.5 +4.1 years. Patients with prostatitis or depression/anxiety were excluded from the investigation or treated previously. We embolizated deep dorsal and Santorini plexus veins for patients with distal form of VOED–47 patients -Group 1. We ligated deep dorsal and penile veins for proximal form of VOED – 68 patients – Group 2. And we made both methods together for 65 patients –Group 3 with combination of proximal and distal leak. Patients with only surgical methods created subgroup A – 105 men. For improving of veno-occlusive mechanism for 73 patients (subgroup B) we injected to each corpus cavernosa 1 mln of autological stem cells 6 times (2 times before, during surgery and 3 times after surgery) each month and we performed 15 microinjections of VEGF each 10 days. Then we compared short (2 months) and long term (10 months) results. Results The efficacy of surgical treatment according to subjective data (questionnaires on IIEF-5) in 2 months was almost equal (16.7+3.1 and 16.9+3.0), but in 10 months significantly higher in SubGroup B(14.3+3.2 and 19.6+3.4). According to Doppler Penile Ultrasound in 10 months adding microinjections ASC and VEGF to surgery significantly improves Erectile function (absence of venous leakage) 56.4% - subgroup A and 87.4% - subgroup B. Only 6.8% patients subgroup B (opposite to 35.9% subgroup A) have to take PDE-5 inhibitors for maintain erectile function. Conclusions Half year injections of ASC and VEGF improve of veno-occlusive mechanism and increases effectiveness and long term result of veno-occlusive operations for treatment of VOED. Combine occlusive method (embolisation and ligation of veins) has the highest effectiveness and should be used in different types of leakage. Disclosure No.