A Combination of Penile Venous Stripping, Tunical Surgery and Varicocelectomy for Patients with Erectile Dysfunction, Penile Dysmorphology and Varicocele under Acupuncture-aided Local Anesthesia on Ambulatory Basis

Abstract

Background: Since 1986, we have refined our combination of penile venous stripping, corporoplasty and varicocelectomy which has proven to be efficacious to patients who suffer from the combination of Erectile Dysfunction (ED), Penile Deviation (PD) and varicocele. It has been developed in tandem with the advances in our understanding of the penile venous, tunical and related anatomy. Herein we sought to report on an approach utilizing the combination of three surgeries for reversing ED, restoring libido and revitalizing the age-related decline in sexual performance. Materials and methods: From June 2010 to March 2012, a total of 35 men, aged from 41 to 49 years, with ED resulting from Veno-Occlusive Dysfunction (VOD), penile deviation and a varicocele. Twenty three (the surgical group) underwent a combination of penile venous stripping, morphological reconstruction and varicocelectomy. Twelve were assigned to the control group. The abridged five-item version of the International Index of Erectile Function (IIEF-5) was used to score the patients. Furthermore, a dual cavernosogram, a prostaglandin E-1 test and a life quality rating were used to assess patients at 6 month intervals. Under an innovative method of acupuncture-aided local anesthesia, and following a circumferential incision, the Deep Dorsal Vein (DDV) and Cavernosal Veins (CVs) were completely stripped and ligated, followed by a pubic median longitudinal skin incision for completing the venous vasculature removal. Tunical surgery was then performed for correcting penile shape. Finally, along the longitudinal pubic wound, a unilateral or bilateral varicocelectomy was performed via a subcutaneous tunnel. Results: The follow-up period ranged from 0.5 to 2.5 years. In the surgical group the average operation time was 4.8 ± 0.3 h. There was no postoperative infection. The preoperative IIEF-5 and the life quality ratings were 9.6 ± 2.1 and 27.3 ± 4.5%, which was increased postoperatively to 20.6 ± 2.3 and 80.8 ± 6.4% respectively (both p<0.001). Whereas in the control group the corresponding preoperative IIEF-5 and life quality ratings were 9.8 ± 2.5 and 29.4 ± 4.4% respectively, in the equivalent postoperative period these changed to 8.8 ± 2.7 and 20.8 ± 6.5% respectively (both p<0.01). The difference between the two groups (p<0.001) and within the group (p<0.01) was significant. A satisfactory penile shape was achieved in 21 (91.3%) patients with 2 men (8.7%) complaining of mild residual deviation of the penis (<10°). Postoperative frenulum edema was limited (3.2 ± 1.6 days). Cavernosograms also demonstrated the ideal milieu of the corpus cavernosum for retaining intracorporeal fluid/blood. Conclusion: A combination of penile venous stripping, penile morphological reconstruction and varicocelectomy provides a novel solution for reestablishing satisfactory and satisfying sexual functioning and performance.