Surgical treatment of penile veno-occlusive dysfunction: is it justified?

Veno-occlusive dysfunction is a commonly diagnosed cause of impotence. Surgical removal of the intermediate (deep dorsal vein and its tributaries) venous system of the penis has been advocated as an effective treatment but recurrence of the dysfunction is common after a few months. We studied prospectively the first 100 cases of veno-occlusive dysfunction undergoing surgical treatment at our institutions.

One hundred consecutive patients undergoing penile venous ligation surgery were evaluated. All patients had a comprehensive workup prior to therapy. Surgery involved excision of the intermediate venous drainage. Short-term results were investigated by personal interview, and long-term outcome was determined by separate telephone interview of patients and their partners when available.

Short-term success (3 months) was 62%, and long-term success (45 months) was 31%. Historical factors, preoperative testing results, and histologic assessment of the surgical specimens were not found to be helpful in predicting outcome.

Despite the mediocre long-term results of the surgical procedure and lack of preoperative predictive factors, we believe that venous leak surgery could be offered to well-selected patients in whom the only other available alternative would be a prosthetic device.