Primary Penile Venous Leakage Surgery With Crural Ligation in Men With Erectile Dysfunction

PurposeWe report our long-term results of penile venous surgery with crural ligation for primary venous leakage in men with erectile dysfunction.Materials and MethodsThe study included 26 men with erectile dysfunction who underwent penile venous surgery for primary venous leakage with at least 1 year of postoperative followup at a single university hospital. All patients underwent penile venous surgery, including resection of the superficial and deep dorsal veins, ligation of the cavernous vein and 2 crura proximal to the entrance of the cavernous artery with umbilical tapes, and preservation of the dorsal artery and nerve on each side. Postoperative evaluation included the 5-item version of the International Index of Erectile Function, physical examination, duplex ultrasound and cavernosography, as necessary. Improvement in erectile functions and patient satisfaction were also assessed as complete, partial and none.ResultsThe mean ± SD International Index of Erectile Function score increased from 6.7 ± 3.61 to 16.3 ± 6.4, which was a highly statistically significant difference (p = 0.001). Postoperatively erectile function improved completely in 11 men (42.3%) and partially in 8 (30.8%), and it remained unchanged in 7 (26.9%). A total of 12 patients maintained satisfactory erection with phosphodiesterase-5 inhibitors, which had not been effective preoperatively. Patient satisfaction with no additional treatment or with phosphodiesterase-5 inhibitors was complete in 15 (57.7%) and partial in 8 (30.7%), while 3 (11.6%) were not satisfied with surgery. These 3 patients underwent penile prosthesis implantation with a 3-piece device.ConclusionsPenile venous surgery with crural ligation for venous leakage has excellent long-term results and patient satisfaction. Therefore, it should be offered to young men with primary cavernous erectile dysfunction. Young patients with normal penile arterial system and no risk factors such as diabetes have the best chance for improved postoperative success.