Combine treatment of veno-occlusive ED withveno-occlusive surgery, injections of stem cells and VEGF

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 veno-occlusive ED (VOED) is the insufficiency venous obstruction in corpora cavernosa under tunica albuginea that is why 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 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 and autological VEGF (Vascular endothelial growth factor) and combine it with veno-occlusive surgery. Materials and Methods On the basis of the Kharkiv Regional Clinical Centre of Urology and Nephrology, Andrology deratment in 2012-2021 we carried out comprehensive examination and treatment of 174 patients with VOED. Most of them 142 (81.6%) have left side or bilateral varicocele. 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 provided embolization of deep dorsal and Santorini plexus veins for patients with distal form of VOED throw deep dorsal vein –46 patients -Group 1.We performed ligation of deep dorsal and penile veins with Marmar surgery from peno-pubical incision for proximal form of VOED – 68 patients – Group 2, And we made both methods together for 62 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 69 patients (subgroup B) we injected to each corpus cavernosa 1 mln of autological endothelial stem cells 5 times (2 times before and 3 times after surgery) each 1.5-2 months and we performed 15 microinjections of VEGF each 10 days. During occlusive operations we injected to ligated veins (deep dorsal and big penile veins) 2 mln of autological fibroblastic stem cells in retrograde direction. Then we compared short (2 months) and long term (10 months) result. 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 objective data in 10 months adding microinjections of autological stem cells and VEGF to surgery significantly improves Erectile function (absence of venous leakage on Doppler Penile US with bemix) 56.4% - subgroup A and 91.4% - subgroup B. Conclusions Half year injections of autological stem cells and VEGF improve of veno-occlusive mechanism and increases effectiveness and long term result of veno-occlusive operations for treatment of VOED. Cavernosografy of combine form of VOED Disclosure Work supported by industry: no.