Antegrade extraperitoneoscopic revascularization of the penis in the treatment of vasculogenic erectile dysfunction.

Abstract

Introduction. Erectile dysfunction (ED) is a multifaceted and widely prevalent problem in modern medicine. The problem of erectile dysfunction has not only medical but also social significance – the presence of erectile dysfunction in men has a deleterious effect on their quality of life. One of the few pathophysiologically substantiated surgical methods of treatment for vasculogenic erectile dysfunction is penile revascularization. Objective. To evaluate the effectiveness of antegrade extraperitoneoscopic penile revascularization in patients with vasculogenic erectile dysfunction, to develop an algorithm for selecting patients with vasculogenic ED suitable for penile revascularization surgery. Materials and methods. From 2015 to 2022, 65 penile revascularizations were performed in patients with vasculogenic ED. All patients were divided into 2 groups. In the main group, antegrade extraperitoneoscopic penile revascularization was performed in 34 patients, while in the control group, penile revascularization was performed in 31 patients according to the Virag-Kovalev method. To assess the results of the treatment, we used the scales and questionnaires IIEF-5, QoL, and the evaluation of penile rigidity on the Erection Hardness Score (EHS) scale. We also compared the duration of surgery and length of hospital stay. Results. The duration of surgery in the main group was significantly shorter (p <0.01) than in the control group. Additionally, the length of postoperative hospital stay was significantly shorter (p <0.05) in the main group. When comparing patients, there was a significant statistical difference in IIEF-5, EHS, and QoL scores. Conclusions. Penile revascularization, particularly the antegrade revascularization method, is an effective method for treating ED. The proposed methodology, based on the shortcomings of previous methods, is the most effective and least invasive of all the presented options. The success of penile revascularization surgery directly depends on careful patient selection and surgeon experience.