[Dorsal ligation of the penile vein--prognostic factors and long-term outcome].
Poor longterm success has been reported for penile vein ligation the last few years. Therefore, we decided to re-investigate our group of 147 patients who were operated on between 1987 and 1996. All patients showed a negative response to intracavernous injection therapy at the time of diagnosis and revealed a maintenance flow > 15 ml/min, as well as a pathological venous flow with pharmacocavernosometry or pharmacocavernosography. These patients underwent ligation of all superficial dorsal veins and resection of the deep dorsal vein of the penis. An up-to-date record of the success of the operation was kept either by a renewed clinical visit or by a standardized telephone interview or questionnaire. A total of 126 patients were available here for long-term follow-up. We divided the findings into three groups: complete spontaneous erection, postoperative response to cavernous autoinjection therapy and no changes in erectile competency postoperatively. The short-term success rate for these groups after 1-3 months was an outcome of 31 (24.6%), 25 (19.8%) and 70 (55.6%) patients; 86% of the cases whose results deteriorated after the initial operation success rate had this happen within the first postoperative year (p < or = 0.001). Favorable prognostic factors were preoperative erectile dysfunction of < or = 7 years, a normal CC-EMG and a maintenance flow of < or = 45 ml/min. If all three parameters were present, the long-term success rate (spontaneous erection plus response to intracavernous injection) of 30% of all patients was found to rise to 67% in this selected group of patients (p < or = 0.001). This study reveals that long-term success for unselected patients undergoing penile venous surgery is disappointing; however, careful selection of patients by certain prognostic factors can improve long-term results.
Schultheiss
D
D
Klinik für Urologie, Medizinische Hochschule Hannover.
Truss
M C
MC
Becker
A J
AJ
Stief
C G
CG
Jonas
U
U
D000328:Adult; D000368:Aged; D006801:Humans; D018783:Impotence, Vasculogenic / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000502:physiology; D010413:Penis / Q000098:blood supply*; D011183:Postoperative Complications / Q000209:etiology*; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000601:surgery*