Same-session dorsal vein ligation and testing by intracavernous injection prior to penile prosthesis implantation (DVL-ICI-PPI).
BACKGROUND
Complications of penile prosthesis implantation (PPI) are rare, nevertheless can be grave. In cases with veno-occlusive dysfunction (VOD), alternative surgical techniques such as dorsal vein ligation (DVL) are controversial. Some patients may opt for trial at DVL to avoid the possible complications of PPI. However, this may be associated with disappointment if DVL fails and another procedure is required.


OBJECTIVE
The aim if this study is to evaluate the results of a combined approach involving DVL, same-session testing by intracavernous injection (ICI) of prostaglandin E1 (PGE1), and immediate implantation of a penile prosthesis (PPI) in case of poor response to DVL.


METHODS
Long-term erectile function in cases with favorable intraoperative response to DVL.


METHODS
Twenty-six patients with refractory VOD were operated upon. Through a peno-pubic incision, DVL was performed, followed by ICI of 20 µg PGE1 in two divided doses, 10 µg each, 15 minutes apart. Group 1 exhibited full rigidity in response to the first dose. Group 2 exhibited full rigidity in response to the second dose. PPI was not performed for either. Group 3 exhibited suboptimal response to both doses, and PPI was performed through the same incision. Patients were followed up from 24 to 48 months using International Index of Erectile Function-5 scoring.


RESULTS
For Group 1 (n = 8), six patients experienced normal erectile function following DVL throughout the whole follow-up period of 48 months (23.1% of all patients), and two patients relapsed. Group 2 (n = 6) (23.1%) reported normal erectile function for an average of 6 months, then relapsed. Group 3 (n = 12) had a penile prosthesis implanted in the same setting.


CONCLUSIONS
Combined DVL-ICI-PPI can spare around 23.1% of young patients with VOD from PPI, at no additional risk. Full response to 10 µg PGE1 at intraoperative testing carries good prognosis to DVL on the long run. Investigation of a larger number of patients is necessary before reaching a final conclusion.
Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt.
Osama
O
Shaeer
Kamal
K
Shaeer
D000328:Adult; D000527:Alprostadil / Q000008:administration & dosage* / Q000627:therapeutic use; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D019935:Penile Implantation / Q000379:methods*; D016896:Treatment Outcome
D000527:Alprostadil
Penile Implant; Penile Prosthesis; Vascular Surgery; Vein Ligation; Veno-Occlusive Erectile Dysfunction; Venoligation