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

Geng-Long Hsu; Eugen Molodysky; Shih-Ping Liu; Hong-Chiang Chang; Cheng-Hsing Hsieh; Chih-Yuan Hsu

doi:10.1016/j.aju.2013.08.009

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

Arab J Urol. 2013 Dec;11(4):375-83. doi: 10.1016/j.aju.2013.08.009. Epub 2013 Sep 17.

Authors

Geng-Long Hsu¹, Eugen Molodysky², Shih-Ping Liu³, Hong-Chiang Chang³, Cheng-Hsing Hsieh⁴, Chih-Yuan Hsu⁵

Affiliations

¹ Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology and Puli Christian Hospital, Nanto, Taipei, Taiwan ; Department of Urology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
² Discipline of General Practice, Sydney School of Medicine, University of Sydney, Australia.
³ Department of Urology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
⁴ Buddhist Tzu-Chi General Hospital, Taipei Branch, Buddhist Tzu Chi University, Hualien, Taiwan.
⁵ Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology and Puli Christian Hospital, Nanto, Taipei, Taiwan.

Abstract

Objective: To report an innovative combination of two surgical procedures to treat patients with erectile dysfunction and penile deviation, arising from advances in penile anatomy.

Patients and methods: From October 1998 to October 2011, 132 men (aged 23-39 years) underwent penile venous stripping and corporoplasty. Of these, 37 were allocated to a transverse and 95 to a longitudinal group, with an infrapubic transverse or pubic median longitudinal approach, respectively. The abridged five-item version of the International Index of Erectile Function (IIEF-5) and cavernosography were used for assessment, as necessary. Under acupuncture-aided local anaesthesia, and after a circumferential incision, the deep dorsal vein and cavernous veins were completely stripped, with 6-0 Nylon sutures for ligation, followed by tunical surgery for correcting the penile shape.

Results: In the transverse and longitudinal groups the mean (SD) duration of surgery was 4.6 (0.2) and 4.8 (0.3) h, respectively. Before surgery the mean (SD) IIEF-5 score was 9.4 (2.3) and 9.6 (2.1), which increased to 20.6 (2.4) and 20.8 (2.7), respectively, after surgery. The penile shape (<15°) was deemed satisfactory in 92% (34/37) and 96% (91/95) of patients in the transverse and longitudinal groups, respectively. The cavernosograms consistently showed a good penile shape. There were significant differences in the mean (SD) duration of penile oedema, at 3.2 (1.6) vs. 11.9 (2.1) days, the overall satisfaction rate and the prevalence of hypertrophied scarring (all P < 0.001).

Conclusion: This combination of unique penile venous stripping with a pubic median longitudinal approach and an anatomy-based corporoplasty is ideally suited to the simultaneous restoration of penile erectile function and morphological reconstruction.

Keywords: CV, cavernous vein; Corporoplasty; DDV, deep dorsal vein; ED, erectile dysfunction; Erectile dysfunction; IIEF, International Index of Erectile Function; PDE1, prostaglandin-E1; Penile deviation; VOD, veno-occlusive dysfunction; Veno-occlusive dysfunction; Venous stripping.