(168) Combining Varicocelectomy and Penile Venous Stripping for Patients with Varicocele and Erectile Dysfunction on an Ambulatory Basis

Abstract

Abstract Introduction Varicocelectomy is a well-established procedure for varicocele testis over one century. It has recently been advanced to minimally invasive surgery types such as laparoscopic or Da Vinci varicocelectomy. Should we question why the approach is beyond the shortest-cut route? Despite penile venous surgery is still cautious in treating patients with erection dysfunction (ED), an anatomy-based penile venous stripping has been conducted for decades, however. It is common to encounter patients with two disease entities. Could the shortest-cut approach be available? Objective We sought to report a novel approach for this purpose on an ambulatory basis. Methods From October 2013 to October 2020, 68 men aged from 28 to 68 years consulted us with erectile dysfunction and varicocele testis, at least grade II. Dual pharmaco-cavernosography and sonography are the primary tools for confirmation, respectively. The abridged five-item version of the International Index of Erectile Function (IIEF-5) erection hardness scales (EHS) was used to assess erection restoration. Acupuncture-assisted local anesthesia was routinely applied on an ambulatory basis. Neither electrocautery nor suction apparatus was used in the entire procedure. They underwent penile venous stripping (PVS) via circumferential approach and, subsequently, to the deeper portion of the erection-related veins via a pubic longitudinal method; later, bi-lateral varicocelectomy was conducted while the spermatic cord was hooked out. The PVS entails stripping one deep dorsal vein and two cavernosal veins after every specific emissary vein is microscopically ligated closest to the outer tunica, whereas the para-arterial veins are segmentally ligated. The visibility of the pampiniform plexus was enhanced by the squeezing method. Finally, the wound was meticulously repaired using a 6–0 nylon suture. Postoperative cavernosography was routinely made for comparison. Radiopacity was used to compare the penile crus, Corpora cavernosa, and femur cortex. Follow-up was made via INTERNET every six months, one year, and then yearly. Results The average follow-up period was 5.2±1.2 years, and the surgery time was 6.3±1. 5 hours, respectively. The blood loss is negligible. The radiopacity was unexceptionally enhanced postoperatively. There was a significant difference (P<0.01) between the preoperative (9.9±2.6) vs. Postoperative IIEF-5 scores (20.6±2.4). The EHS improved on at least one scale. Overall, the post-ejaculation testicular aching was no more bothered in all 23 patients who sustained preoperatively in 6 months postoperatively. Conclusions This combination of physiologically penile venous stripping and bilateral varicocelectomy appears feasible for patients with erectile dysfunction and varicocele via a circumferential and pubic approach on an ambulatory basis. Disclosure No.