Combining Erection Restoration and Factual Penile Enhancement Based on Revolutionary Penile Fibro-Vascular Assembly.

Introduction It has been controversial in penile venous surgery for erection restoration and penile enhancement across three centuries thus far. Objective Based on the De Novo penile fibro-vascular assembly, we report an anatomy-physiology-based combination of a physiological penile corporeal diameter expansion and erection restoration surgery in recent decades. Methods From 2012 to 2022, intractable impotence and subjective micropenis prompted 23 men to seek penile venous stripping (PVS) and factual penile enhancement (TPE). All patients received dual cavernosography demonstrating penile venous anatomy and veno-occlusive dysfunction. PVS entailed the venous stripping of one deep dorsal vein and two cavernosal veins after every emissary's vein was double ligated 0.3 cm apart closest to the outer tunica with a 6-0 nylon suture. In addition, the para-arterial veins were just segmentally ligated. In TPE, a longitudinal incision was performed bilaterally over 3 and 9 O'clock positions along the pendulous penis. Every tunic defect was then water-tight sutures with a 7x3 cm rectangle venous stripe as an inner tunica bilaterally, subsequently covered with a piece of 7x3 venous wall, fascia tense lata, or a controlled tissue integration material sheet for surrogating the outer layer bilaterally. On penile girth and glans penis, the diameter was measured preoperatively and postoperatively in six months when a cavernosography was conducted, if available. Radio-opacity was used to compare the femoral cortex and the penile crus on preoperative and postoperative cavernosography. Additionally, the abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) was used to confirm improvement preoperatively and postoperative follow-up yearly either by telephone or INTERNET. Results The average follow-up period was 5.3±0.8 years. The operation time was 7.2±1.8 hours. The material of outer patches was fascia tense lata (n=3), Surgifrom (n=6), penile vein (n=8), internal spermatic vein (n=3), and cephalic vein (n=3). The radiopacity was unexceptionally enhanced postoperatively. It was a significant difference between the preoperative and postoperative IIEF-5scores (9.7±2.8 vs. 20.8±2.3; P<0.01). The EHS improved at least one scale. The diameter of the glans and distal penile shaft is increased from 2.78±0.33 cm and 3.41±0.41 cm (n=18) to 2.98±0.32 cm and 3.49±0.31 cm, respectively. Although the satisfaction rate is only 70.0% (16/23), the intracorporeal retention and erection quality improvement were unexceptional. Conclusions This novel combination strategy of factorial penile enhancement and erection restoration is feasible. However, it requires a more significant sample size and longer-term follow; the surgery technology is conspicuously challenging. Disclosure No

Introduction: Traditional penile venous surgery and enhancement have been controversial. Based on De Novo penile fibrovascular assembly, we report on penile venous stripping (PVS) and factual penile girth enhancement (FPGE). Methods: From 2013 to 2023, 18 men underwent PVS and FPGE, all confirmed with veno-occlusive dysfunction (VOD). PVS involves the stripping of erection-related veins. FPGE was performed along the tunica albuginea bilaterally; then, the two tunic defects were repaired with a 70.0x30.0 mm venous stripe and covered with either autologous venous walls (AVW, n=10) or Surgiform (SF, n=8). The penile girth was measured, and radio-opaque contrast was used. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score and the Erection Hardness Scale (EHS) were used yearly during follow-up via the Internet. Results: The follow-up period was 5.3±1.5 years. Radiopacity was consistently enhanced. Although there was indifference between AVW and SF, there was a significant improvement (both P＜0.01) in IIEF-5 and EHS scores (9.7±2.8 vs. 20.8±2.3; 1.7±0.6 vs. 3.2±0.2, respectively). Both the diameters of the glans and penile shaft increased (28.0±2.3mm and 28.3±2.1mm vs 35.3±2.2mm and 36.3±2.1mm respectively). The satisfaction rate was 81.3% (13/16). Conclusions: This novel combination of PVS and FPGE is promising, although a larger sample size is needed for further validation.

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

Introduction Given the penile fibro-vascular assembly was just thoroughly interpreted recently and inspired by impotent patients' questions during daily practice, so does the penile venous stripping (PVS), which is deemed controversial thus far. Despite primary impotence (PI) being ascribed to psychogenic origin, in the large repository of PVS treating PI, some 5 % remain refractory in the last decade, an analysis deemed required. Objective We sought to report penile crural dysplasia or hypoplasia that prevents sustainability compared to most PVS males thus far. Methods A retrospective analysis was conducted internationally on 45 consecutive young men with PI from 2013 to 2023. They were allocated into the crural dysplasia group (CDG, n=8), defined as a 50% diameter difference between the largest penile crus and corresponding corpus cavernosum or a 25% diameter difference of bilateral penile crura, and no crural-dysplasia group (NCG, n=37). On an ambulatory basis under acupuncture-aided local anesthesia, neither electrocautery nor a suction apparatus is used, with a circumferential or semi-circumcision followed by a pubic longitudinal approach, the PVS entailed the erection-related vein, including stripping a deep dorsal vein, two cavernosal veins after each emissary's vein was firmly ligated closest to the outer tunic layer with a 6–0 nylon suture. In contrast, the four para-arterial veins were only segmentally ligated. The overlying fascia layers and skin were approximated with a 6–0 nylon and 5–0 chromic suture for the skin, as did the semi-circumcision wound if it existed. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) were used to assess erection restoration; preoperative data were based on masturbation; additionally, a radio-opacity index was used for comparison of the femoral cortex and that of penile crus preoperative and postoperative, respectively. Follow-up was primarily made via either INTERNET or telephone yearly. After this May, we introduced an autologous venous patch to augment the crural hypoplasia with a promising outcome on two new patients. Statistically, IBM SPSS 21.0 was used. Results The follow-up time was from 0.1 to 10.0 years, averaging 5.7 ± 1.1 years in the CDG and NCG groups, respectively. The blood loss is negligible. There is no difference between the operation time (4.9−0.8 hours vs. 4.8 ± 0.7 hours, p> 0.88) for the CG and EG group, respectively. In both groups, there is a significant of IIEF-5 scores, EHS (5.7±2.0 vs. 15.9±2.1, 1.8±0.8 vs. 2.5±0.6; 5.8 ±2.1 vs. 22.4±1.1, 1.8±0.9 vs. 3.6±0.3; both P<0.001) between the CDG and NCG. The preoperative radio-opacity of penile crura was unexceptionally enhanced postoperatively. In the NCG, 89.1% (33/37) are gratified; in contrast, 37.5% are satisfied in the CDG five years postoperatively, although surgery benefit is unexceptional reported. A close follow-up is going on with the two new males. Conclusions Penile crural hypoplasia is an unidentified contributor to primary impotence, although a larger sample size and longer-term follow-up are warranted. Disclosure No.

Introduction: Herein, we explore whether coil embolization (CE) is effective in treating veno-occlusive dysfunction (VOD). We present five cases with seven CE episodes and a narrative literature review. Methods: From 2013 to 2018, refractory impotence prompted five men to seek penile vascular stripping (PVS), although seven CE episodes were included. All received dual cavernosography in which erection-related veins and VOD were documented. PVS entailed the venous stripping of one deep dorsal vein and two cavernosal veins. The abridged five-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) were used, and yearly postoperative follow-ups were conducted via the Internet. Using Pub Med, a narrative literature review was performed on CE treatment for VOD or varicocele. Results: Inserted coils were scattered along the erection-related veins, including the deep dorsal veins (n = 4), periprostatic plexus (n = 5), iliac vein (n = 5), right pulmonary artery (n = 2), left pulmonary artery (n = 2), and right ventricle (n = 1). PVS resulted in some improvements in the IIEF-5 score and EHS scale. Six articles highly recommend CE treatment for VOD. All claimed it is a minimally invasive effective treatment for varicocele. Conclusions: CE is not justified as a VOD treatment, regardless of its viability in the treatment of varicocele.

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.

Introduction Albeit present human penile anatomy has remained unchanged for three thousand centuries and extensive study has been conducted on anatomical architecture and male potency reconstructive strategies for many centuries, it might not above be sustainable. Objective Given only evidence can speak volumes, and practice is the criterion for testing truth, we sought to report an innovative circumferential approach for fulfilling penile erection restoration and morphology reconstruction on an ambulatory basis microsurgical in recent years Methods From October 2013 to October 2020, 33 men aged 21–59 underwent penile venous stripping (PVS) and corporoplasty via a circumferential approach on an ambulatory basis. The abridged five-item version of the International Index of Erectile Function (IIEF-5), erection hardness scales (EHS), and cavernosography were used for assessment, as required. 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. Subsequently, a tunic corporoplasty is conducted before and after artificial erection with autologous venous wall bi-layered patches, whereby a water-tight running suture is undertaken for the inner layer and interrupted for the second layer for idealizing penile morphology using 6-0 nylon. Results The average follow-up period was 5.1±1.3 years, and the surgery time was 5.2±1. 4 hours, respectively. The radiopacity was unexceptionally enhanced postoperatively. There was a significant difference (P<0.01) between the preoperative (9.8±2.7) vs. Postoperative IIEF-5 scores (20.7±2.3). The EHS improved on at least one scale. The penile shape (<10°) was deemed reported in 93.9% (31/33) patients. Conclusions This combination of physiologically penile venous stripping and an anatomy-based corporoplasty is ideally suited to the simultaneous restoration of penile erectile function and morphological reconstruction via a circumferential approach. Disclosure No.

Introduction Albeit the present human penile anatomy has remained unchanged for three thousand centuries, and extensive study has been conducted on anatomical architecture and male potency reconstructive strategies for many centuries, it might not above be sustainable. Objective Given only evidence can speak volumes, and practice is the criterion for testing truth, we sought to report an innovative circumferential approach for fulfilling penile erection restoration and morphology reconstruction on an ambulatory basis microsurgical in recent years. Methods From October 2013 to October 2020, 33 men aged 21–59 underwent penile venous stripping (PVS) and corporoplasty via a circumferential approach on an ambulatory basis. The abridged five-item version of the International Index of Erectile Function (IIEF-5), erection hardness scales (EHS), and cavernosography was used for assessment, as required. 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. Subsequently, a tunic corporoplasty is conducted before and after artificial erection with autologous venous wall bi-layered patches, whereby a water-tight running suture is undertaken for the inner layer and interrupted for the second layer for idealizing penile morphology using 6-0 nylon. Results The average follow-up period was 5.1±1.3 years, and the surgery time was 5.2±1. 4 hours, respectively. The radiopacity was unexceptionally enhanced postoperatively. There was a significant difference (P<0.01) between the preoperative (9.8±2.7) vs. Postoperative IIEF-5 scores (20.7±2.3). The EHS improved on at least one scale. The penile shape (<10°) was deemed reported in 93.9% (31/33) patients. Conclusions This combination of physiologically penile venous stripping and anatomy-based corporoplasty is ideally suited to the simultaneous restoration of penile erectile function and morphological reconstruction via a circumferential approach. Disclosure No.

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.

Herbs have been regarded as aphrodisiacs in treating impotence for many centuries despite little true scientific evidence. Our latest refined penile venous stripping (PVS) technique is effective in treating impotence, although this procedure remains controversial. A synergic effect of PVS and oral herbs was confirmed in our practice but lacked rigorous scientific proof. The objective of this report was to review our experience with this combination. From August 2010 to May 2014, 263 males underwent PVS. Among these, 67 unsatisfied men chose additional salvage therapy and were randomly assigned to oral herbs (n=35) or placebo treatment (n=32) which replaced herb eventually. All were evaluated with the international index of erectile function (IIEF-5) scoring and our dual pharmaco-cavernosography. The pre-op IIEF-5 score for the herb group was 9.7±3.7, post-operative 13.9±3.3 and post-herb 19.6±3.4, while the control group scores were as follows: pre-op 9.3±4.1, post-op 14.5±3.6, post-placebo 15.1±3.5 and post-herb 19.9±3.2. Although there was no significant difference between the two groups pre-operatively, post-operatively and post-herb, a statistically significant difference was found post-salvage therapy (19.6±3.4 versus 15.1±3.6, P<0.001). It appears that the combination of oral herbs and PVS treatment provides an enhanced outcome to impotent patients refractory to medicine and unsatisfied with PVS monotherapy alone.

Reconstructive surgery for idealising penile shape and restoring erectile function in patients with penile dysmorphology and erectile dysfunction

Introduction There are varied approaches for conducting varicocelectomy and penile venous surgery, which are not unified or conspicuously, being not above controversy in the later type either in methodology or routes for accessibility thus far. Objective We sought to present this innovative method in a novel combination of a physiological penile venous stripping and bilateral varicocelectomy via a single longitudinal pubic wound on an ambulatory basis. Methods From July 2012 to December 2021, 63 consecutive patients underwent this combined surgery. Primary diagnosis tools are dual cavernosography and doppler sonography. A 4-5cm longitudinal pubic incision is two-thirds above the penile pubic fold. A blunt dissection maneuver using a hemostat or finger creates a space between the Colles' and Buck's fascia. The entire penis is then released with an inside-out maneuver resulting in Buck's fascia being exposed exclusively, followed by firmed ligation of every emissary vein of the corpora cavernosa via 6-7 open-to-open schemes on Buck's fascia, subsequently stripping of the deep dorsal vein (DDV) and paired cavernosal veins (CVs). In contrast, the para-arterial veins are just ligated segmentally. Reduction of the penis is made after Buck's openings are repaired with not too tight square knots with 6-0 nylon. The stripping of the DDV and CVs is completed after 125-137 ligatures until the infra-pubic angle. Finally, the spermatic cord is hooked below the inguinal canal outlet level. On each side of the varicocele, ligation of 8-11 spermatic veins is macroscopically performed at no expense of ruining all other tissues, even the fragile lymphatic vessel. Then meticulous repair is obtained layer by layer. This novel approach is likely the most appropriate method for making a milking maneuver which is helpful in vascular differentiation on both corpora cavernosa and pampiniform plexus during the entire procedure to prevent residual veins from offensive. Results The average follow-up period is 5.3±0.5 years. There is a significant (9.6±2.7 vs. 20.9±2.3; P&amp;lt;0.01) between the preoperative and postoperative IIEF-5 scores. So does the EHS scale (1.6±0.3 vs. 2.9±0.3; P&amp;lt;0.01) between the preoperative and postoperative status. The radiopacity was unexceptionally enhanced postoperatively. Although the intracorporeal retention and erection quality improvement were unexceptional, the satisfaction rate is just 71.4% (45/63). Penile length resumed 3.5 months postoperatively, although two patients initially complained about 1-2 cm postoperative shortage. Conclusions From the physiology viewpoint, we would like to recommend this promising method with which the shortcut to express. Disclosure No

Although various compartments of the human cardiovascular system have been thoroughly elucidated, the penile fibrovascular assembly remains an exception that has yet to be fully explored; therefore, this gap in our understanding prompts us to conduct further investigations. This study revisits the penile-fibro-vascular assembly to determine whether it constitutes an independent vascular compartment within the human body. The penile-fibro-vascular assembly was meticulously examined in 23 male human cadavers. The loupe-assisted observation was used to compare the size of bilateral penile arteries, conspicuously addressed at the hilum, and to isolate erection-related vascular channels meticulously with a loupe, as extensively as possible. Additionally, a comprehensive library was analyzed, including 801 cadaveric images, 1001 sets of dual cavernosographies, 11 spongiosographies, 7 Magnetic Resonance Imaging (MRI)/computed tomography (CT) cavernosographies, 61 Doppler's sonographies, and 15 selective internal pudendal arteriographies. Hemodynamic phenomena were observed both intra-corporeally and extra-corporeally in patients who underwent penile venous stripping (n = 501), coil embolization (n = 6), and pudendal arterial stenting (n = 5). This study confirms the existence of an independent penile fibro-vascular hydraulic environment within the human cardiovascular system. The human penis contains an independent bi-layered fibrovascular assembly. Anatomical symmetry of bilateral arteries is rare on the arterial side. On the venous drainage side, there is one deep dorsal vein (DDV), two cavernosal veins, and four para-arterial veins, contrary to the conventional understanding of only a single DDV between the tunica albuginea and Buck's fascia. The penile venous drainage blood ultimately returns to pulmonary circulation. Penile vascular surgery, particularly penile venous stripping, is shown to be the most physiologically appropriate method for restoring erectile function; contrarily, erection-related arterial stents, or venous embolization do not offer similar benefits. This study's strength lies in its extensive analysis of a large repository of anatomical, physiological, radiographic imaging, and clinical vascular data; however, its retrospective nature represents a limitation. This study demonstrates that the penile fibro-vascular assembly functions as an independent vascular system, substantially making it the last vascular compartment to be disclosed in the human body.

Management of erectile dysfunction in patients who failed prior vascular intervention

EVALUATION OF MALE SEXUAL FUNCTION BY THE INTERNATIONAL INDEX OF ERECTILE FUNCTION AFTER DEEP DORSAL VEIN ARTERIALIZATION OF THE PENIS