MODERN METHODS OF CORRECTION OF VEIN-OCCLUSIVE ERECTILE DYSFUNCTION

Abstract

Aim: to study the long-term effectiveness of stimulation of the vein-occlusive mechanism by the addition of autologous stem cells and PRP therapy in the surgical removal of venous leak.Materials and Methods: comprehensive examination and treatment of 156 patients with vein-occlusive erectile dysfunction was carried out. Most of them – 112 (82.9%), – had left-sided or bilateral varicocele. In 86 patients of the first group with a proximal form of vein-occlusive erectile dysfunction, ligation of deep dorsal veins and veins of the penis and Marmara operation from a foam-pubic incision were performed. In 49 patients of the second group with a distal form of vein-occlusive erectile dysfunction, embolization of deep dorsal veins and veins of the Santorini plexus was performed through a conductor in the deep dorsal vein of the penis. To improve the venous occlusion mechanism, 1 million autologous endothelial stem cells and 2 millions autologous fibroblast stem cells were injected into each cavernous body, which were activated by vascular growth factor into the ligated veins (deep dorsal and large veins of the penis) in a retrograde direction during occlusive operations for 48 patients (groups 1b and 2b, respectively) and compared long-term results.Results: The effectiveness of surgical treatment according to subjective data (IIEF questionnaire) – after 2 months was almost equal, but after 18 months it was significantly higher in subgroups 1b and 2b (68,9% и 75,5) and according to objective data (no venous leakage with dopplerography of the penis), after 18 months in 73.4% and 91.4%, respectively.Conclusions: The use of autologous (endothelial and fibroblast) stem cells with the course of PRP therapy improves the veno-occlusive mechanism, increases the efficiency and long-term results of vein-occlusive surgeries for the treatment of VOED, creating an effective alternative to phalloprosthetics for men with this problem.