I have surgery in 10 days! - Need your help/advice/more info.

hi guys , checkin back in into the discussion :


Well 2 Weeks ago , I had this full duplex scan , as mentioned above. "doppler sonographie" is its correct name.

What I thought it would be was : I get hard then they scan my dick and meausure blood-inflow and blood outflow.

In reality it was : They fuckin sting a needle in your dick and inject a mixture of something that makes the bloodflow visible (Kontrast mittel) and prostaglandin 20mg to make it hard.
This was , without any doubt at all the WORST PAIN I EvER FELT in my whole entire life !!! They injected it into my right chamber and for the next 20 second I was fuckin screaming and cursing in agony.
The purpose of this was to draw blood from the body into the penis , as in "natural erection"-at the same time measure the bloodflows. The only shit that happend was : my dick swell up like if something blunt violently hit it, but didn't get erect at all. (the sideffects were supposed to be : priapism for up to 6 hours an stuff like that)
Well ,
No natural erection = No way of correctly measuring the in and out flow relation = completly failed attemped at diagnosing what is wrong with my dick.
Well , actually that is a statement too. so since this failed , the doc knew something was wrong with the outflow, and from my description he knew its probably was the vein leakage or spongy tissue leakage....

The normal next investigation step is more invasive but also completely shows and finds every leak in the dick.

the method is called : CAVERNOSOGRAPHIE in german.

Google for it if you want all the details.

Short version is : they put 2 - 3 needles in your dick and then through a pump-system they artificially fill the dick with some sort of salt (saline or something) and again something to make the veins and arteries and chambers visible in x-ray. Your dick will enlarge completely, it will be x-ray scanned and each and every blood leak will be found.

Downside is : You have 2-3 needles IN YOUR FUCKIN SpONGY TISSUES all the time. It will hurt as hell, thats, what the doctor said. Also sidefeffects like scarring , severe scarring , complete inflammation of the spongy tissue with complete scarring of all tissues can develope.

I made an appointment for tuesday 19th april , wich is/was today.

So I had 2 weeks to think about my situation and the cavernosographie:

I very well understood that this Cavernosographie is the next logical step in diagnosing the exact locations of the leakage and that if I do this I have the highest chances of completely recovering.
However, like with everything in life , THE more Risk, the more you can WIN. And I sure as hell didn't want to risk , shit like scarring , or inflammation , or complete impotence just becase of the cavernosographie alone. I'm not kidding myself here...every sting in the spongy tissue leaves a scar , maybe atiny one maybe ig one , maybe it will develope to peyronies...too dangerous for me..

So I had to find a way around the standard procedere. My plan was to get the docotors and specialists to do the vein ligation surgery on all deformed veins WITHOUT the damn cavernosographie. Vein ligation is pretty damn simple and you absolutely cannot become impotant . They just fuck with the topical veins and thats it.
Of course now that the risk would be lower , my chance of completely recovering would be lower too. What if the reason for the high outflow , INDEED was the damn "spongy tissue bloodleak" then it don't matter how may veins they cut , I'll still end up where I was before. On the other hand , if the enemy really was those damn outter veins , I might be fully recovered too. If it works out , I'm fine , if not , I still can do the cavernosographie , and even if that fails i could get a damn implant (they are absolutely undetectable nowadays - of course this is the last option I would ever consider)

I guess you can understand my logic.

I wrote a long-ass letter to the specialist , describing each and every detail of my problem , and also proposing my idea of handling the problem to him.
Guess what , he wrote back and said , yeah,... lets talk again then decide if we do the cavernosographie or not.

So today we talked , and BOY AM I HAPPY AnD FULL OF HOPenis Enlargement AGAIN ! After a long talk HE AGREED to do the vein ligation surgery WITHOUT THE DAMN CAVERNOSOGRAPHIE !!!! He said , there is no risk of becoming impotant or damaging more than is damaged now AT ALL ! The only downside is that the successrate of this is exactly only 20%
for the first 2 years. Doesn't sound to promising you think ? I think its exactly 20 times better than "NO CHANCE" or "severe scarring". Over-next friday I have the appointment for the surgery and I don't even have to pay for it , insurance does so ! The doctor was very impressed with my knowledge on this matter , and he admitted that most urologists, and doctors , don't know half of the shit that I wrote to him in the letter. I guess he also had a heart for a young desperate guy like me...

OK now listen close what we both decided to do and what the surgery will be like :

He wants to make a cut at the side , above the penis , at the pubic bone. then through this opening pull up and out the "skinned" "penis base" (in other words the lower part of the penis without the skin covering it.) Then he wants to shut down and cut all the veins around the penis. The only vein left , will be the deep dorsal vein. I wondered why he wanted to leave that , he said because if the reason for your ED is a lack of blood inflow we will be able (have option) to do another surgery later : The revascularisation surgery , and we will revascularize the deep dorsal vein then. I'm like ok , if you say so...he also mentioned that the ligation of the deep dorsal vein is more dangerous than what we are planning to do , because the nerve bundles are directly right and left , next to it. So again , I'm like ok lets do the first thing and see what happens later.


Ok now I'm at home..and I'm getting second thoughts again. Its definetly good that we do the surgery, but now that hedoesn't want to cut the deep dorsal its again more variables...it could be the spongy leak and it could be a deep dorsal vein leak. I googled for similar cases and found lots of guys who have just a leak from the deep dorsal AND that was enough to render them impotent. Then they got the deep dorsal ligated and fully recovered again... I don#t know..maybe its good to cut the deep dorsal too , maybe its not , maybe its good to have this other chance of revascularizing the deep dorsal , maybe its not good ??!?

What I'm doing now is : I want to collect as many similar cases , as many information as I can , maybe talk to other specialists from other countries.. I have 10 days till the surgery and if I find something that is a significantly better idea than what we planned now , I'm sure the doctor will agree to do that, too.

Guys pls help me out. Help search for whatever information on -

-vein ligation
-deep dorsal vein ligation
-revascularization surgery
-embolization of penile veins and so on...

Just post it here in this thread and I keep checking in. Also all your thoughts and ideas on this topic are more than welcome..
moderators , pls don't move this to booboos and bandaids, let my plea get some attention , maybe someone has the right advice , the missing link ?! Its just a matter of 7 days where I could still talk to the doc and maybe make a change..then you can remove it for sh0 !

For those who are interested you can find more about my story in this thread. A guy nicknamed provider started it and I kinda hijacked myself into it...




erection problems

VENOUS DRAINAGE

The venous drainage system consists of three distinct groups of veins—superficial, intermediate and deep. The superficial drainage system consists of venous drainage from the penile skin and prepuce which drain into the superficial dorsal vein that runs under the superficial penile fascia (Colles’) and joins the saphenous vein via the external pudendal vein. The intermediate system consists of the deep dorsal vein and circumflex veins that drain the glans, corpus spongiosum and distal two-thirds of the corpora cavernosa. The veins leave the glans via a retrocoronal plexus to join the deep dorsal vein that runs in the groove between the corpora. Emissary veins from the corpora join the circumflex veins; the latter communicate with each other at the side by lateral veins and corresponding veins from the opposite side, and run under Buck’s fascia before emptying obliquely into the deep dorsal vein. The latter passes through a psace in the suspensory igament and between the puboprostatic ligament and drains into the internal iliac veins. The deep drainage system consists of the cavernous vein, bulbar vein and crural veins. Blood from the sinusoids from the proximal third of the penis, carried by emissary veins, drains directly into the cavernous veins at the periphery of the corpora cavernosa. The two cavernous veins join to form the main cavernous vein that lies under the cavernous artery and nerves. The cavernous vein runs between the bulb and the crus to drain into the internal pudendal vein; it forms the main venous drainage of the corpora cavernosa. The crural veins arise from the dorsolateral surface of each crus and unite to drain into the internal pudendal vein. The bulb is drained by the bulbar vein, which drains into the prostatic plexus.

LYMPHATIC DRAINAGE

The lymphatics from the penile skin and prepuce run proximally towards the presymphyseal plexus and then divide to right and left trunks to join the lymphatics from the scrotum and perineum. They run along superficial external pudendal vessels into the superficial inguinal nodes, especially the superomedial group. Some drainage occurs through the femoral canal into Cloquet’s node. The lymphatics from the glans and penile urethra drain into deep inguinal nodes, presymphyseal nodes and, occasionally, into external iliac nodes

The progression of the penile vein: could it be recurrent?

Chen SC, Hsieh CH, Hsu GL, Wang CJ, Wen HS, Ling PY, Huang Hydromax, Tseng GF.

Microsurgical Potency Reconstruction and Research Center, Taiwan Adventist Hospital, 424 Pa-Te Road, Sec 2, Taipei 105, Taiwan, ROC.

Our aim was to study retrospectively the destiny of the deep dorsal vein of the penis in the event of its stripping surgery or its simple ligation in patients diagnosed with venoocclusive dysfunction 17 years ago. From June 1986 to May 1987, a total of 31 men were seen for erectile dysfunction due to venous leakage resulting from priapism, aging, or congenital or idiopathic factors. Of these, 23 men underwent venous stripping of the deep dorsal vein and are referred to as the stripping group. The remaining 8 patients received a simple ligation of the deep dorsal vein and are classified as the ligation group. A total of 21 patients (16 of the 23 and 5 out of the 8) were available for follow-up by using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) scoring system and cavernosograms. In the ligation group, the imaging demonstrates some compensatory veins that are commensurate with impotence postoperatively. In the stripping group, however, the follow-up cavernosograms disclosed no venous recurrence, but residual ones that were not crucial to the rigidity. The IIEF-5 scoring in the ligation group changed from a preoperative mean IIEF-5 score of 10.0 +/- 4.5 to 9.8 +/- 3.6 postoperatively. In the stripping group, however, the mean preoperative IIEF-5 score of 9.8 +/- 4.1 increased to a mean postoperative IIEF-5 score of 18.9 +/- 2.1. Although there was no significant difference between the 2 groups' preoperative IIEF-5 score, there was a statistically significant difference between treatments (P <.001). The penile venous vasculature bears no evidence of regeneration even as long as 17 years after their removal. This finding is in contrast to what is commonly believed, that erectile dysfunction will recur about 2 years after ligation of the deep dorsal vein. We therefore believe that the clinical recurrence may not be due to venous regeneration, and penile venous surgery, if properly performed, may be durable, although larger studies will be required.

Fuck me ! Muahahahha, thats me exactly !!!!



Penile blunt trauma induced veno-occlusive erectile dysfunction.

Tsao CW, Lee SS, Meng E, Wu ST, Chuang FP, Yu DS, Chang SY, Sun GH.

National Defense Medical Center, National Defense University, Taipei, Taiwan, ROC.

Blunt trauma to the pelvic or perineal region of the corpora cavernosa is a risk factor for the subsequent development of persistent erectile dysfunction. The hemodynamic investigation of the integrity of the veno-occlusive mechanism has been rare in cases of traumatic impotence. We present two young men with erectile dysfunction following blunt penile or perineal trauma. Combined intracavernous injection and stimulation test, color duplex ultrasonography, and pharmacologic cavernosometry and cavernosography revealed normal arterial velocity and pulsation without cavernosal arterial fistula, but severe venous occlusion and site-specific abnormal veins were noted in both patients. They received penile vein ligation procedure and resulted in near-completely normal erectile function after a four-year followup. Penile venous ligation, especially on the site-specific veins, is still the choice of treatment for the trauma-induced penile veno-occlusive erectile dysfunction, and the result is satisfactory.

Is dorsale penile vein ligation (DPVL) still a treatment option in veno-occlusive dysfunction?

Cakan M, Yalcinkaya F, Demirel F, Ozgunay T, Altug U.

Department of Urology, SSK Diskapi Training Hospital, Turkey.

PURPOSE: To determine the long-term results of the DPVL for the treatment of venous impotence. PATIENTS AND METHODS: The long-term results of DPVL in 134 patients were interviewed. The mean age was 39.2 (range 21-72). Power color doppler imaging, pharmacocavernography/dynamic cavernosometry were performed. Postoperatively, all the patients were controlled in the 6th month, first year and, if possible, once a year. The mean follow-up was 54.8 (14-76) months. Postoperative outcomes were classified into 3 groups: complete spontaneous erection (CR), response to pharmacotherapy (PR) or no satisfactory improvement (NR). RESULTS: The short-term success in the 6th month according to above mentioned was 38.8%, 18.6% and 42.5%; and in the first year was 19.4%, 14.9% and 65.6% respectively. The result in 35 patients whose follow-up was at least 5 years (mean 67 months) was 11.4%, 14.3% and 74.3% respectively. Positive prognostic factors were preoperative age <40, duration of erectile dysfunction <2 y, non-smoker patients, non neurogenic disease and distal disease. With all these parameters present, long-term success (CR, PR) rose from 33.6% to 55.9% (p < 0.001). CONCLUSIONS: Long-term success for unselected patients undergoing DPVL is disappointing; however, careful patient selection significantly improves long-term results.

Long-term results of dorsal penile vein ligation for symptomatic treatment of erectile dysfunction.

Popken G, Katzenwadel A, Wetterauer U.

Department of Urology, University Hospital, Freiburg, Germany.

About 20% of patients with erectile dysfunction do not react to intracavernous pharmacological treatment (SKAT) because of a cavernous leak. The first attempt to treat venous insufficiency goes back as far as the beginning of the century. Ligature and resection of the superficial and deep veins of the penis (DPVL) were performed in 122 patients (nonresponders to SKAT with a maintenance flow of less than 40 ml min-1). Twenty-four patients suffered from primary dysfunction and 98 from secondary dysfunction. The average age of the patients was 49 years, and the average duration of the preoperative erectile dysfunction 4.4 years. Postoperative follow-up was carried out for 70 months. In 98% of the patients, cavernosography revealed a dorsal leak. Twenty-six per cent had ectopic veins, 38% a leakage through the crural veins and 24% a glandular or spongiosal shunt. After the 70-month follow-up, only 14% of the 122 patients were able to achieve an adequate spontaneous erection and 19% also responded to SKAT. Depending upon the time elapsed since the operation, the rate of spontaneous reaction was reduced. It was found that younger patients with a short history of erectile dysfunction, no arterial cofactor, a maintenance flow of less than 100 ml min-1 and a severe dorsal leakage from a DPVL were the most likely to benefit from this procedure. Since degeneration of smooth muscle cells of the cavernosa is in most patients the cause of the venous leakage, penis vein surgery is to be regarded as symptomatic treatment.

[Long-term results of venous surgery for cavernous erectile dysfunction]

[Article in Japanese]

Kawanishi Y, Kimura K, Yamaguchi K, Nakatuji H, Kishimoto T, Kojima K, Yamamoto A, Numata A.

Department of Urology, Takamatsu Red Cross Hospital.

BACKGROUND: It is well known that the effectiveness of venous surgery declines during the follow-up period. The onset of recurrence after surgery varies greatly among patients. There are only a few studies which have evaluated the effectiveness of venous surgery with objective tests. METHODS: We treated 123 cases of cavernous erectile dysfunction with venous surgery, and evaluated the results objectively. We performed intracavernous injection tests using 20 micrograms of prostaglandin E1 every 3 months until the recurrence of cavernous erectile dysfunction. RESULTS: Mean follow up period was 32 months (0.2-134.0 months). According to the Kaplan-Meier analysis, the effectiveness of surgery at 1 year, 3 years, 5 years, and 10 years was 85%, 61%, 30%, and 26%, respectively. CONCLUSION: There was no statistically significant difference between the outcomes following deep dorsal vein surgery and crural ligation surgery. Operative complications were more frequent, however in deep dorsal vein surgery.

I can't offer any real advice since this stuff is way over my head but I wish you luck.

Is deep dorsal vein arterialization an alternative surgical approach to treat venogenic impotence?

Anafarta K, Aydos K, Yaman O.

Urology Department, School of Medicine, University of Ankara, Turkey.

OBJECTIVE: Several surgical techniques have been applied for the treatment of cavernosal venous leakage, sufficient enough to create erectile dysfunction. In light of the variable success rates, we report our experience with deep dorsal penile vein arterialization for the management of severe cavernosal venous leakage. PATIENTS AND METHODS: Twenty-four impotent patients with venous leakage were treated by the Virag-II type of end-to-end anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally. Diagnostic evaluation included color flow Doppler sonography before and after intracavernous 60 mg papaverine injection and dynamic cavernosometry/ cavernosography, which indicated veno-occlusive dysfunction in 28 patients. Revascularization was technically possible in 24 of the patients, although in 4 anastomosis could not be achieved due to the poor quality of the inferior epigastric artery. RESULTS: Five patients had early occlusion in the immediate postoperative period and 4 had late occlusion within 8 months. Potency was improved initially in 9 (38%) of the 24 patients in whom successful anastomosis had been achieved, with longer term improvement in 6 (25%) of 24 who realized restoration of erectile potency as defined by clinical investigations. The mean follow-up was 24 months (range 3-36 months). CONCLUSION: We believe that anastomosis of the inferior epigastric artery to the deep dorsal penile vein and ligation of the vein proximally in cases of venous leakage results in a low success rate due probably to a pancavernosal alteration in corporal tissue compliance.

Ok this is alot information, I know , but I can cut through it for you easily. The difficult part is to decide what to do and what not to do.

Again my doc wants to cut all the topical veins and none of the deep dorsal.
He wants to leave the dorsal to keep the future option of revascularization of this.

The articles I posted are all of different dates (years).
The older the article (like from 1999) the more shit they talk about vein ligation and low success rate. The newer the articles , like from 2004 , or 2005 the higher the success rate and report of complete recovering and spontanious erections.

The last article clearly show that revascularision of the deep dorsal vein makes no sense.

besides all of that : The ligation of the deep dorsal veins is more dangerous (due to the nerves , and the "deeper" access" through more tissue)

The decision that I have to make is :

Do I tell my doc to go ahead AND also ligate all the deep dorsal veins, cos the revasularization makes no sense. Or do I prepare myself for many many surgerys :

1 surgery : Cut all veins, but not the deep dorsal.

If no sucess ,

most probably they will only agree if i do the cavernosographie thing:

2 second surgery : Cut the deep dorsal, or revascularization.

no success

Implant , or wait untill they can implant smooth muscle tissue and spongy tissue , wich will probably be 10 years, fuck.

Tough decision , hardly any time to decide ? Ain't that a bitch...

Do you have any idea how you got leaks in your spongy tissue?

A leak in the spongy tissue is the last thing on earth that u want to have. Don't imagine it like a certain spot somewhere in a corpus cavernosum that leaks blood back into the penis, its not like that , your dick would be red or blue all the time , or hematoma and so on.

When I or they , mention a sponggy tissue blood leak , then its meant that the whole tissues, the smooth muscles cells have degenerated or atrophied and thus don't do the job they are supposed to do , you know what I mean.

the smooth musclecells relax the spongy tissues fill with blood (the spaces inbetween) fill more and more until the whole sponge presses against the tunica. And now when it presses against the tunica , veins become occluded , the outflow is severly restrictid , you have a perfect , throbbing , hard erection.
If the muscle tissue is degenerated , it doesn't expand as good or as far as it used to , s it can#t press against the tunica hard enough , so no veins get occluded, the bloodoutflow remains unrestricted , thats a spongy tissue bloodleak. You can have perfectly healthy veins , but if for some reason your sponges are fucked , you are fucked to my friend and the only option right now is : completely removing the both corpus cavernosum chambers and implanting an implant. Those implants are undetectable , visually and by touch , so its not the worst option out there...you still keep your nerves and glans and corpus spongiosum and still can have sex and orgasms. To get erect you push some trigger in a ball of yours and then the implant chambers fill with something that makes them "erect" . To go back to normal you do the same....pretty simple...however the last thing I would want on this earth....

wow, that sounds pretty scary to be honest. i mean it would be cool to control your erections however you wanted, but not by means of a 'trigger', or anything unnatural.

I really hope this goes good for you man, you seem to know your shit about this and I'm glad you questioned your docs about stuff cuz your right they dont know shit!!

tbirdy said:

To get erect you push some trigger in a ball of yours and then the implant chambers fill with something that makes them "erect" . To go back to normal you do the same....pretty simple...however the last thing I would want on this earth....

Click to expand...

So, your saying you make a secret spot on yourself like the back of your left nut and you push a button and it fills up, that is amazing....i didnt know they could do stuff like that......wow
Ignition in 5, 4, 3.............

damn you're a brave man. How the hell did this happen exactly? Did your doc ask you anything specifically? Did you tell him about Penis Enlargement and ask his views?

man they options out now days are amazing. they have things like the old pumps they put in shoes and you can pump when you want by pressing on your pubic bone area. plus I remember hearing of others. sort of freaks me out. for me...no knife down there.

tbirdy I wish ya the best of luck. and hopefully afterwards you can still Penis Enlargement. keep us posted.

Damn dude...I am doing some searches, maybe they will help.


Penile Revascularization Surgery
Also known as microvascular arterial bypass surgery for impotence

Penile revascularization surgery is similar to a cardiac bypass, but in the penis. It is for healthy men less than 50 years old with no evidence of a venous leak upon testing. The most common causes of erectile dysfunction which can be treated by penile revascularization are blunt trauma to the perineum or bike riding.

This procedure is highly specialized and requires extensive training in microvascular surgery as well as special equipment in the OR. Physicians at the Center for Sexual Medicine have performed more than 700 revascularization procedures over the last 20 years.

Most ideal candidates are young men with a history of perineal or pelvic trauma in whom arteriography reveals a localized common penile artery lesion.

Those with generalized vascular pathology are poor candidates for this operation as the same disease will likely affect the revascularized segment in the years following surgery.

Revascdularization is achieved by microsurgical anastomosis of the inferior epigastric artery to the dorsal penile artery.

The donor artery is carefully dissected from its origin at the femoral artery to a more distal point near the umblicus where it is transected.

The cut artery is then brought through the inguinal ring into the scrotum for microvascular anastomosis to the right or left dorsal artery.

Adherence to strict patient selection criteria will yield excellent longterm patency and patient satisfaction results.

Penile revascularization surgery for arteriogenic erectile dysfunction: the long-term efficacy rate calculated by survival analysis.

Kawanishi Y, Kimura K, Nakanishi R, Kojima K, Numata A.

Department of Urology, Takamatsu Red Cross Hospital, Kagawa, Japan.

OBJECTIVE: To determine the subjective and objective outcomes (by survival analysis) after penile revascularization surgery in patients with arteriogenic erectile dysfunction (ED), selected by established strict criteria. PATIENTS AND METHODS: The study included 51 patients diagnosed with arteriogenic ED caused by localised arterial lesions and who had microscopic penile revascularization surgery between January 1996 and March 2002. Before surgery, all patients had a full examination, including a medical and sexual history, laboratory testing, intracavernosal pharmacological tests, colour Doppler ultrasonography (CDU), pharmacodynamic infusion cavernosometry and cavernosography, and digital subtraction angiography (DSA). Penile revascularization surgery was indicated only in patients aged <50 years and with no history of diabetes mellitus, hypertension or hyperlipidaemia. When there were communicating branches between the dorsal and cavernosal arteries, Hauri's procedure was used; when there were none or there was no evidence for them on both CDU and DSA because of severe narrowing or obstruction in the proximal common penile artery, the Furlow-Fisher modification of the Virag V procedure (FFV5) was used. The patency of the neo-arterial blood flow was assessed by CDU and effective rates calculated using the Kaplan-Meier method. The efficacy rate was recalculated whenever there was a recurrence. When occlusion of the neo-arterial blood was confirmed by CDU the date of occlusion was set as that midway between the last examination showing patency of the donor vessel and the latest examination indicating the occlusion. The patency period was the number of days from surgery to the date of occlusion. RESULTS: Of the 51 patients, 26 had Hauri's and 23 the FFV5 procedure (median age 32 years, range 21-49); in two patients with a previous pelvic fracture surgery was not possible because of scar formation in the dorsal area at the base of the penis. The mean (sd) subjectively estimated efficacy rate was 85.9 (6.3)% after 3 and 67.5 (10.7)% after 5 years of follow-up. The duration at 75% efficacy was 41.0 (5.6) months. The objectively estimated efficacy rate was 84.9 (7.3)% at 3 and 65.5 (13.5)% after 5 years of follow-up. The duration at 75% patency was 42.4 (9.5) months, and at 50% was 60.6 (19.4) months. There was no significant difference in subjective outcome between the FFV5 and Hauri procedures (P = 0.38, log rank test) and none objective outcome after surgery (P = 0.19, log rank test). Thirteen of the 18 patients in the Hauri group had venous dilatation in the deep dorsal, obturator, prostatic and the internal iliac veins. There were operative complications in four patients (hyperaemia of the glans in two, and one each with haemorrhage from the anastomosis site and scar contracture). CONCLUSIONS: The long-term efficacy rates (by the Kaplan-Meier method) of the Hauri and FFV5 procedures were both acceptable. The selection criteria gave acceptable outcomes from both procedures. Penile revascularization surgery is a treatment suitable only for young men and therefore attention must be given not only to the long-term outcome but also to long-term adverse events.

Penile Vein Ligation/Embolization

Several approaches to penile vein ligation have been used. The initial approach of single-vessel ligation of the dorsal vein was expanded due to poor results. A range of ligation procedures varied in their aggressiveness have emerged and range from dorsal and accessory vein ligation to complete ligation and excision of the dorsal, cavernous, and crural veins. (6) More recently dorsal vein embolization has been used alone or in combination with surgery to decrease the invasiveness of therapy. Two small case series have published promising short term results. (7,8) Deep dorsal vein arterialization has been proposed to increase venous outflow pressures and compensating for veno-occlusive dysfunction. Preliminary evidence indicates promise in treating mixed arterial and veno-occlusive disease. (9)

Success rates for surgical procedures for veno-occlusive disease generally have been poor. Success rates within the first year range from 23% to 80% and consistently decrease with longer-term follow-up (14% to 77% at one year). Reasons proposed for the inadequate long-term results include inadequate surgical ligation of veins, the development of collateral bypasses, especially spongiosal leaks, corporal myopathy, and neurotransmitter deficiencies. Diseases such as diabetes and hypertension along with substances such as nicotine can cause damage to corporal smooth muscle cells. Damage at the cellular level produces deficits in erectile physiology that is not compensated for directly by venous ligation. Surgery may address a symptom of the disease but not the disease process, accounting for the poor results seen over the long-term in patients with smooth muscle dysfunction.

[Results of deep dorsal vein ligation for venogenic impotence]

[Article in Japanese]

Kawanishi Y, Tamura M, Kagawa S.

Department of Urology, Takamatsu Red Cross Hospital.

We treated seventy venogenic impotence with ligation of the deep dorsal vein of the penis. Their corporal veno-occlusive function was evaluated by dynamic infusion cavernosometry and cavernosography (DICC). Under local anesthesia, we made a longitudinal skin incision at the base of the penis. The deep dorsal vein was ligated and also a portion of this vein of 1.5 cm long was resected together with branches surrounding the vein. After the operation, the infusion rate determined by DICC was confirmed to be decreased in almost all patients. Thirty nine out of seventy cases had their erectile capability restored and reported that they could achieve sexual intercourse. Sixty one of the seventy cases showed full erection together with an intracavernous papaverine injection. However fifty percent of the sixty one patients who became capable of obtaining erection with the treatment had lost their erectile capability again within one year of the operation, however the other fifty percent were shown to maintain their erectile capability for up to three years. As four years after the treatment only thirty percent of those who had achieved the initial erectile capability still remained potent. This operation is easy to perform without any major complications, and its outcome is as good as that achieved by other more invasive venous ligation in the treatment of patients with venogenic impotence. We therefore conclude that penile deep dorsal vein ligation and partial resection of the vein one of the most useful treatments currently available for venogenic impotence and should be the treatment of choice.