Shaeer, O, El-Shaarawy, E, Emam, H, Elsisi, I, Sokar, E

Veno occlusive erectile dysfunction; venous leak; dorsal vein ligation; internal pudendal vein ligation; internal pudendal vein embolization

Vein ligation surgery for veno-occlusive erectile dysfunction (VOD) by deep dorsal vein ligation (DVL) or embolization is not widely performed. This is considering the failure rates and recurrence rates 1. One of the causes of failure is missing some venous outlets at the time of surgery 2, such as the deep system of veins. So far, the deep system of veins is surgically inaccessible.

Shaeer’s Vein Ligation-I (SVL-I), the first surgical technique for ligation of the main trunk of the deep system of veins; internal pudendal vein (IPV). Ligation point is where IPV courses around the ischial spine, through a gluteal incision. This work is a cadaveric exploration and evaluation of surgical feasibility. To our knowledge, this is the first report of this approach.

The ischial spine and consequently IPV were found to be at the intersection between two lines: one bridging the posterior superior iliac spine to the ischial tuberosity, and a another extending from the sacro-coccygeal joint, laterally. IPV is thus accessible via a medial gluteal incision, subcutaneous fat dissection, and splitting the gluteus maximus muscle fibers along their direction. A protocol for a surgical study is registered at clinicaltrials.gov , and is open for participation.

[1] Cakan M, Yalçinkaya F, Demirel F, Ozgünay T, Altuğ U. Is dorsale penile vein ligation (dpvl) still a treatment option in veno-occlusive dysfunction? Int Urol Nephrol. 2004;36: 381-7.

[2] LEWIS RW. After a Decade of Venous Surgery - Is there a Place for it in 1996? In: Porst H, ed. Penile Disorders. Germany: Springer; 1996:230-31.