Penile venous surgery – prognostic factors and long-term results

Poor longterm success has been reported for penile vein ligation the last few years. Therefore, we decided to re-investigate our group of 147 patients who were operated on between 1987 and 1996. All patients showed a negative response to intracavernous injection therapy at the time of diagnosis and revealed a maintenance flow > 15 ml/min, as well as a pathological venous flow with pharmacocavernosometry or pharmacocavernosography. These patients underwent ligation of all superficial dorsal veins and resection of the deep dorsal vein of the penis. An up-to-date record of the success of the operation was kept either by a renewed clinical visit or by a standardized telephone interview or questionnaire. A total of 126 patients were available here for long-term follow-up. We divided the findings into three groups: complete spontaneous erection, postoperative response to cavernous auto-injection therapy and no changes in erectile competency postoperatively. The short-term success rate for these groups after 1–3 months was an outcome of 31 (24.6 %), 25 (19.8 %) and 70 (55.6 %) patients; 86 % of the cases whose results deteriorated after the initial operation success rate had this happen within the first postoperative year (p K 0.001). Favorable prognostic factors were preoperative erectile dysfunction of K 7 years, a normal CC-EMG and a maintenance flow of K 45 ml/min. If all three parameters were present, the long-term success rate (spontaneous erection plus response to intracavernous injection) of 30 % of all patients was found to rise to 67 % in this selected group of patients (p K 0.001). This study reveals that long-term success for unselected patients undergoing penile venous surgery is disappointing; however, careful selection of patients by certain prognostic factors can improve long-term results.