PENILE VENOUS SURGERY - PROGNOSTIC FACTOR S AND LONG-TERM RESULTS

Poor longterm success has been reported for penile vein ligation the l ast few years. Therefore, we decided to re-investigate our group of 14 7 patients who were operated on between 1987 and 1996. All patients sh owed a negative response to intracavernous injection therapy at the ti me of diagnosis and revealed a maintenance flow > 15 ml/min, as well a s a pathological venous flow with pharmacocavernosometry or pharmacoca vernosography. These patients underwent ligation of all superficial do rsal veins and resection of the deep dorsal vein of the penis. An up-t o-date record of the success of the operation was kept either by a ren ewed clinical visit or by a standardized telephone interview or questi onnaire. A total of 126 patients were available here for long-term fol low-up. We divided the findings into three groups: complete spontaneou s erection, postoperative response to cavernous autoinjection 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 (2 4.6 %), 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 less than or equal to 0 .001). Favorable prognostic factors were preoperative erectile dysfunc tion of less than or equal to 7 years, a normal CC-EMG and a maintenan ce flow of less than or equal to 45 ml/min. If all three parameters we re present, the long-term success rate (spontaneous erection plus resp onse to intracavernous injection) of 30% of all patients was found to rise to 67 % in this selected group of patients (p less than or equal to 0.001). This study reveals that long-term success for unselected pa tients undergoing penile venous surgery is disappointing; however, car eful selection of patients by certain prognostic factors can improve l ong-term results.