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Long-term results of penile venous ligation for corporeal venous occlusive dysfunction
A A Hassan1, M M Hassouna, M M Elhilali
1Division of Urology, McGill University, Royal Victoria Hospital, Montreal, Que.
Objective:
To evaluate the long-term results of penile venous ligation in patients with erectile dysfunction due to venous incompetence of the corpora cavernosa.
Design:
A retrospective case study with follow-up longer than 22 months.
Setting:
A university teaching hospital.
Patients:
Thirty-two men with penile corporeal dysfunction, ranging in age from 33 to 77 years (mean 45 years). The duration of impotence ranged from 8 to 66 months (mean 29 months). The results were evaluated by chart review and patient questionnaire.
Intervention:
Ligation of the penile cavernosal and crural veins.
Main Outcome Measures:
Penile-brachial index (PBI), peak flow rate in the cavernosal arteries after injection of papaverine, penile rigidity and maintenance of perfusion rate during cavernosometry, all measured preoperatively and compared postoperatively, and major venous leakage, defined as leakage into both the deep and the intermediate systems.
Results:
Ten (31%) of the 32 patients had a good result (full rigid erection without adjuvant therapy postoperatively) and 9 (28%) showed improvement (full erection with intracorporeal injection). Of the 13 (41%) failures, 7 had temporary improvement, ranging from 6 to 20 months. Preoperative penile rigidity, PBI and peak blood-flow velocity were significantly higher in patients with good results than in those with poor results (68% versus 40%, p < 0.05). Major venous leakage occurred in 12 of 13 patients with poor results but in only 1 of the patients with good results.
Conclusions:
The success or failure of penile venous ligation should not be evaluated during the 1st year after the procedure. The presence of minor leakage and penile rigidity greater than 60% are good predictors of the success of the procedure.