(533) Penile Venous Stripping for Treating Patients with Erectile Dysfunction Secondary to a Minimally Invasive Prostatectomy

Abstract

Abstract Introduction A minimally invasive prostatectomy becomes a treatment of choice in patients with operable prostate cancer. However, it is not uncommon to encounter patients with erectile dysfunction (ED) secondary to this procedure. Objective Although there are many ED treatment strategies, we want to report a physiological penile venous stripping surgery to those patients whose ED was secondary to prostatectomy and refractory to all medical treatments in the recent decade. Methods From 2012 to 2021, 15 consecutive patients, aged 62 to 79, sustained erectile dysfunction (ED) following a minimally invasive prostatectomy for treating prostate cancer. Meanwhile, their ED was refractory to contemporary varied treatment strategies, including one 70-year-old patient non-responsive to 800 mg sildenafil. All patients received dual cavernosography in which the penile venous anatomy was shown by a pilot cavernosograpy, PGE-1 test in-between, and a veno-occlusive dysfunction (VOD) was documented by pharmaco-cavernosography. Eventually, they underwent a physiologically penile venous stripping surgery (PVSS) for erection restoration from VOD. The ambulatory basis was unexceptionally conducted under acupuncture-assisted local anesthesia. PVSS begins with a circumferential approach, followed by degloving those tissues superficial to the Colles' fascia until the penile base. Next, it entailed stripping a deep dorsal vein and two cavernosal veins while fixing every emissary's vein with 6-0 nylon closest to the outer tunica. In contrast, the two pairs of para-arterial veins were only segmentally ligated. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and corporeal radio-opacity assessed erection restoration. Additionally, the erection hardness scale (EHS) confirmed improvement. Results The prostatectomy was performed in laparoscopic (n=7) and Da Vinci surgical system (n=8) elsewhere. The average follow-up period was 5.3±0.4 years. It was unexceptionally pronounced on the radiopacity of the corpora cavernosa to the femoral cortex, denoting the intracorporeal retention established in the corpora cavernosa after PVSS. It was statistically significant between the preoperative and postoperative IIEF-5 scores (5.9±1.8 vs. 11.8±2.6, P<0.01). The EHS improved at least one scale. Surprisingly, two patients reported gratifying outcomes although they were committed to Parkinsonism. Overall, just 42.9% (9/21) of patients reported unaided sex. The remaining patients required medication aid every five men depending on 20 mg sildenafil and 5 mg vardenafil, respectively. Eventually, four resorted to malleable penile implants, which firmly declined preoperatively. Conclusions PVSS is beneficial in managing some groups of males whose ED is secondary to a minimally invasive prostatectomy, although the sample size is limited. Disclosure No