Penile Fibro-Voruilon Assembly and Venous Stripping Surgery for ED

Mohamed Salim Al-MarhoonOman Moderator

Geng-Long HsuTaiwan Speaker Penile Fibro-Voruilon Assembly and Venours Stripping Surgery for EDBackgrounds: Humans have existed on earth for 3000 centuries, so does penile fibro-vascular assembly, which is an exclusive milieu for applying Pascal's law if there is no veno-occlusive dysfunction (VOD), or older-termed venous leakage. The corpora cavernosa (CC), incorporated distal ligament, is the primary compartment for establishing bony rigidity. Despite extensive studies for centuries, the medieval illustration of penile fibro-vascular anatomy has prevailed in literature since 1519. Consequently, it has been unsuccessful in all derived penile reconstructive strategies, particularly the merit of penile venous surgery, which has been disputed since 1895, when Duncan introduced it in the United States. Recently, a penile fibro-vascular assembly was proven to be an independent compartment in the cardiovascular system. We sought to report on the male potency reconstructions, specifically the penile venous stripping for erection restoration, refined chronologically since 1985, in Taiwan. Methods: Reviewing a four-decade journey, reciprocating between penile fibrovascular anatomy and Taiwanese penile venous stripping surgery (PVSS) strategy, from the 1986 prototype to the USPTO patent version in August 2012, we reviewed a vast repository in our 3488 surgeries since 1986. Under acupuncture-assisted local anesthesia, the acupoints of Hegu (LI4), Shou San Li (LI10), and Waiguan (TE5) are chosen routinely. All patients received dual cavernosography in which a pilot cavernosograpy demonstrated the innovative, intriguing penile venous anatomy, a PGE-1 test in between, and a pharmaco-cavernosography documented a veno-occlusive dysfunction (VOD). Among them, 3488 PVS surgeries had been performed. Neither an electrocautery nor a suction apparatus is used. All surgeries were conducted on an ambulatory basis with acupuncture-assisted local anesthesia. PVSS entailed the venous stripping of a deep dorsal vein and a pair of cavernosal veins after every emissary vein was fixed firmly closest to the outer tunica albuginea with a 6-0 nylon suture. Meanwhile, segmental ligation was conducted on two pairs of para-arterial veins. Routinely, postoperative cavernosograms were obtained for comparison. The abridged 5-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS) were used to confirm improvement in preoperative and postoperative follow-up via the INTERNET yearly. Statistically, the Wilcoxon signed rank test and Fisher's exact test were used as necessary. Results: The operation time is 4.7±1.4 hours, varied widely between 3.5 h and 7.5 h with a mean of 4.7h. , and the blood loss is 15.8±4.6 mL. There was a significant difference (both P＜0.01) in preop. And postop. IIEF-5 and EHS scores (9.7±2.8 vs. 20.8±2.3; 1.7±0.6 vs. 3.2±0.2, respectively. Although the intracorporeal retention and erection quality improvement were profound unexceptionally, improved rate was defined as an IIEF-5 increasement of 3 scores out of 25 and EHS up warding at least one scale; accounting for 50.0 to 95.7%; however, the gratifying rate varies between 55.5% to 85.8% with available follow-up for longer than a decade. In the adolescent-onset impotence, natural coitus can be achieved in 3 out of the five patients. Discussion and conclusion: Given that refractory ED prompted most patients to seek our PVSS, it is noteworthy that PVSS appears to be beneficial to most ED patients of all ages. Particularly, with an ultimate understanding of penile fibrovascular assembly involving the erection veins and apagogical erection process through hemodynamic research via fresh and defrosted cadaveric penises, Taiwanese PVSS warrants spreading to young surgeons. Take-home message: The conventional penile anatomy is merely one circumferential layer model of tunica albuginea surrounding the corpora cavernosa (CC) and one deep dorsal vein draining corporeal blood; as evidenced by research, innovative terms such as erection-related veins, penile venous stripping surgery (PVSS), and penile fibro-vascular assembly are underpinned and implemented in Taiwan. Human penile fibrovascular assembly involves the fibrous bi-layered tunica albuginea model with a 360° inner circular and 300° outer coat surrounding the CC; the erection-related veins are one deep dorsal vein (DDV), two cavernosal veins (CVs), and four para-arterial veins. Each vein has emissaries connecting to the CC sinusoids. The relationship between DDV, CVs, and emissaries resembles that of rattan root nodes to a yam vine: multiple smaller yams can sprout if the root remains intact, which occurs at the expense of the main vine's ability to support a single giant yam; this agricultural principle guided the design of our PVSS approach. Taiwanese PVSS requires neither electrocautery nor suction apparatus. Although most of the medical community worldwide does not agree with it, PVSS is beneficial in correcting veno-occlusive dysfunction and has outstanding results. The traditional complications of irreversible penile numbness and deformity have been virtually negated with the venous ligation technique superseding venous cautery. Despite not being agreed upon in most of the medical community, penile venous stripping surgery is beneficial in correcting veno-occlusive dysfunction, with outstanding results. The traditional complications of irreversible penile numbness and deformity have been virtually negated with the venous ligation technique superseding venous cautery. Although many urological surgeons regard the PVSS surgery niche as unreachable, it is achievable, akin to the capability of performing microsurgery on a small rat. Taiwanese PVSS is likely the exclusive physiological way to ensure erection restoration and a natural way of glans expansion. So PVSS, which ought to decline AI assistance, should be shared with young surgeons. Key Words: cavernosal vein, erectile dysfunction, deep dorsal vein, para-arterial vein, veno-occulusive dysfunction, penile venous stripping surgery, penile fibro-vascular assembly, erection-related veins References: 1. Hsu, G. L., Chang, H. C., Molodysky, E., Hsu, C. Y., Tsai, M. H., Yin, J. H., & Chen, M. T. (2025). A detailed analysis of the penile fibro-vascular assembly. 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