(217) LAPAROSCOPIC AND OPEN SURGERY FOR LIGATION OF DORSAL PENILE VENOUS LEAKS: REPORT OF 76 PATIENTS WITH 18-MONTH FOLLOW-UP
Authors: Uribe J , Uribe C 
Published: December 2024

Abstract

Introduction
Dorsal penile venous occlusive dysfunction is increasingly recognized as a significant contributor to erectile dysfunction (ED), especially among younger patients experiencing ED onset before the age of 40 without other common risk factors.

Objectives
This study aims to explore the outcomes of surgical correction, either through open or laparoscopic approaches, in patients diagnosed with ultrasound-confirmed venous leaks. Follow-up assessments were conducted for up to 18 months post-treatment to evaluate intervention effectiveness and durability.

Methods
A retrospective descriptive study was conducted on 76 patients meeting inclusion criteria, who underwent standardized venous ligation surgeries between January 2014 and January 2024. These surgeries, performed by the same surgeon, involved either open penile surgery or laparoscopic ligation of the Santorini plexus. Patient evaluations included pre- and postoperative symptom scoring using the International Index of Erectile Function-5 (IIEF-5) at intervals of 3, 6, 12, and 18 months. These IIEF-5 results were correlated with the degree of ED: severe (1-7 points on the IIEF-5), moderate (8-15 points on the IIEF-5), and mild (16-21 points on the IIEF-5) pre- and postoperatively. Furthermore, patients were categorized based on an internal analysis of the IIEF-5 scores as follows: successful, indicating an increase of 6 points or more from the preoperative IIEF-5 score, achieving a final score of 17 or higher, and advancing at least one category in the IIEF-5 scale; moderate, signifying an IIEF-5 score ranging from 12-16 points; and poor, characterized by an increase of 5 points or less in the IIEF-5 score and/or a final score below 11 points. The diagnosis of venous leaks was confirmed through penile Doppler ultrasound with vasoactive agent administration. Approval for the study protocol was obtained from the Research Committee of HPTU.

Results
The average age of patients seeking consultation was 31.35 years, with ED onset occurring between 14 and 39 years (mean 23.9 years), and disease duration ranging from 1 months to 24 years (average 9.5 years) before surgery. Preoperatively, 9.2% had severe ED, and 90.7% had moderate ED. Postoperatively, 36.84% showed no ED, 36.84% had mild ED, 26.31% had moderate ED, and none had severe ED at 18 months. The surgical corrections were 20% laparoscopic and 80% open. Additionally, according to internal analysis of the IIEF-5: Successful outcomes were observed in 65% of patients, moderate outcomes in 13%, and poor outcomes in 22%. Predictors of poor correction outcomes were surgeries performed after age 40 and severe preoperative fibrosis. Among patients using oral PDE5 inhibitors preoperatively, 57.6% became responders postoperatively.

Conclusion
Our findings indicate that dorsal penile venous ligation yields promising results in terms of mid to long-term improvement in erectile quality, potential for achieving cure, response to PDE5 inhibitors, and overall patient satisfaction. As such, it emerges as a viable alternative for young men suffering from erectile dysfunction attributed to this etiology.

Disclosure
No.