Is deep dorsal vein arterialization effective in elderly patients?

Kayıgίl, Önder; Agras, Koray; Okulu, Emrah

doi:10.1007/s11255-007-9304-9

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…These data stay in contrast to a further study, published in 2008 [17]. Kayigil et al defined subjective success after pure venous arterialization as a score increase of at least 5 points noted postoperatively in the five-item version of the IIEF (IIEF-5).…”

Section: Results Of Penile Revascularizationmentioning

confidence: 71%

Standard Operating Procedures for Vascular Surgery in Erectile Dysfunction: Revascularization and Venous Procedures

Sohn

Hatzinger

Goldstein

et al. 2013

The Journal of Sexual Medicine

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Introduction The impact of penile blood supply on erectile function was recognized some 500 years ago. At the turn of the 20th century first results of penile venous ligation were published and in 1973 the first surgical attempts to restore penile arterial inflow were undertaken. Numerous techniques were published in the meantime, but inclusion criteria, patient selection, and success evaluation differed extremely between study groups. Aim To develop evidence-based standard operating procedures (SOPs) for vascular surgery in erectile dysfunction, based on recent state of the art consensus reports and recently published articles in peer-reviewed journals. Methods Based on the recent publication of the consensus process during the 2009 International Consultation on Sexual Medicine in Paris, recommendations are derived for diagnosis and surgical treatment of vascular erectile dysfunction. In addition several recent publications in this field not mentioned in the consensus statements are included in the discussion. Main Outcome Measure The Oxford system of evidence-based review was systematically applied. Due to the generally low level of evidence in this field expert opinions were accepted, if published after a well-defined consensus process in peer-reviewed journals. Results Referring to penile revascularization it may be concluded, that in the face of missing randomized trials, only recommendations grade D may be given: this kind of surgery may be offered to men less than 55 years, who are nonsmokers, nondiabetic, and demonstrate isolated arterial stenoses in the absence of generalized vascular disease. The evidence level for recommendations concerning penile venous ligations may be even lower. Too many unsolved controversies exist and universal diagnostic criteria for patient selection as well as operative technique selection have not been unequivocally established. This kind of surgery is still considered investigational but may be offered in special situations on an individualized basis in an investigational or research setting after obtaining written consent, using both pre- and postoperatively validated measuring instruments of success evaluation. Conclusions SOPs for penile revascularization procedures can be developed, concerning a highly selected patient group with isolated arterial stenoses. Based on the available data it is not yet possible to define SOPs for surgical treatment of corporal veno-occlusive dysfunction.

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Section: Results Of Penile Revascularizationmentioning

confidence: 71%

Standard Operating Procedures for Vascular Surgery in Erectile Dysfunction: Revascularization and Venous Procedures

Sohn

Hatzinger

Goldstein

et al. 2013

The Journal of Sexual Medicine

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“…Similarly, in 2005, the AUA Update on the Management of ED [25] , and the International Society for Sexual Medicine textbook, Standard Practice in Sexual Medicine [26] maintained the consensus. However, it might deserve reappraisal after a review of arterial reconstructions reported after 2004 ( Table 2 ) [27–32] , Interestingly, researchers unexceptionally report positive long-term outcomes when both penile arterial and venous reconstruction are incorporated, suggesting that arterial reconstruction alone is insufficient for the long-term restoration of erectile function. For investigating the vascular contribution exclusively, haemodynamic studies have been used in both fresh and defrosted human male cadavers since 2001 [33] .…”

Section: A Review Of Arterial Revascularisation/veno-arterialisation mentioning

confidence: 99%

Penile vascular surgery for treating erectile dysfunction: Current role and future direction

Molodysky

Liu

Huang

et al. 2013

Arab Journal of Urology

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Penile vascular surgery for treating erectile dysfunction (ED) is still regarded cautiously. Thus we reviewed relevant publications from the last decade, summarising evidence-based reports consistent with the pessimistic consensus and, by contrast, the optimistically viable options for vascular reconstruction for ED published after 2003. Recent studies support a revised model of the tunica albuginea of the corpora cavernosa as a bi-layered structure with a 360° complete inner circular layer and a 300° incomplete outer longitudinal coat. Additional studies show a more sophisticated venous drainage system than previously understood, and most significantly, that the emissary veins can be easily occluded by the shearing action elicited by the inner and outer layers of the tunica albuginea. Pascal’s law has been shown to be a significant, if not the major, factor in erectile mechanics, with recent haemodynamic studies on fresh and defrosted human cadavers showing rigid erections despite the lack of endothelial activity. Reports on revascularisation surgery support its utility in treating arterial trauma in young males, and with localised arterial occlusive disease in the older man. Penile venous stripping surgery has been shown to be beneficial in correcting veno-occlusive dysfunction, with outstanding results. The traditional complications of irreversible penile numbness and deformity have been virtually eliminated, with the venous ligation technique superseding venous cautery. Penile vascular reconstructive surgery is viable if, and only if, the surgical handling is appropriate using a sound method. It should be a promising option in the near future.

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“…However, in spite of all these admonitions, a review of the recent literature on this subject between 2003 and the present time of this writing shows there have been several publications on virtually every aspect of CVOD: basic science and hemodynamics [124][125][126][127], pathogenesis [128][129][130][131][132], investigations [127,133], surgery [111,[134][135][136][137][138][139][140], prognosis [141,142], and post-operative changes [143].…”

Section: Levels Of Evidencementioning

confidence: 99%

“…Surprisingly, there has only been one retrospective case series published in the literature since 2003 [111]. The lack of further studies may reflect consensus opinion, such as American Urological Association (AUA) guidelines [68] which state that, “Treatment of vasculogenic ED by penile arterial revascularization has been performed using a variety of microvascular procedures for the past 30 years.…”

Section: Arterial Revascularizationmentioning

confidence: 99%

“…Despite the negative opinion by the AUA consensus panel on penile revascularization surgery and the poor outcome from the comparative study by Wespes [115], Kayigil recently published a paper that supported the efficiency of deep dorsal vein arterialization (DDVA) in carefully selected healthy elderly patients [111]. Forty‐three patients with a mean age of 59.7 ± −4.6 years underwent corpus cavernosum electromyography, DICC, and penile duplex Doppler ultrasonography.…”

Section: Arterial Revascularizationmentioning

confidence: 99%

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Implants, Mechanical Devices, and Vascular Surgery for Erectile Dysfunction

Hellstrom

Montague

Moncada

et al. 2010

The Journal of Sexual Medicine

140

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Introduction The field of erectile dysfunction (ED) is evolving and there is a need for state-of-the-art information in the area of treatment. Aim To develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery. Methods To provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period. Main Outcome Measure Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Results The inflatable penile prosthesis (IPP) is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis. Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma. Currently, surgery to limit venous leakage is not recommended. Conclusions It is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient’s medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery.

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Is deep dorsal vein arterialization effective in elderly patients?

Abstract: DDVA could successfully be performed for carefully selected elderly patients as long as the presence of risk factors for ED are ruled out.

Cited by 8 publications

References 17 publications

Standard Operating Procedures for Vascular Surgery in Erectile Dysfunction: Revascularization and Venous Procedures

Standard Operating Procedures for Vascular Surgery in Erectile Dysfunction: Revascularization and Venous Procedures

Penile vascular surgery for treating erectile dysfunction: Current role and future direction

Implants, Mechanical Devices, and Vascular Surgery for Erectile Dysfunction

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