What is it about?

This study introduces a combined surgical approach designed to help men who struggle with severe erectile dysfunction caused by venous leakage and who also want penile girth enhancement. The authors describe two procedures performed together: 1. Penile Venous Stripping (PVS) A technique that removes or ties off veins that leak blood too quickly during an erection. This helps the penis retain blood more effectively, improving erection quality. 2. Factual Penile Girth Enhancement (FPGE) A method that adds structural support along the tunica albuginea (the tough outer layer of the erectile bodies). The surgeons create two small openings and reinforce them using either: the patient’s own vein tissue, or a material called Surgiform. This reinforcement increases penile girth and helps stabilize the erectile bodies. What the Study Found Among 31 patients with confirmed venous leakage: 18 received the combined surgery, and 13 served as controls. The surgery group showed: Significant improvement in erectile‑function scores (IIEF‑5 and EHS) Better blood retention on imaging after surgery Increased glans and shaft diameter (both statistically significant) High satisfaction rates (over 80% in one subgroup) In Simple Terms The article is about a new surgical method that aims to: restore erections by fixing venous leakage increase penile girth in a controlled, anatomical way improve long‑term stability and patient satisfaction The authors argue that this combined approach shows promise, but larger studies are needed to confirm the results.

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Why is it important?

1. It offers a new option for men with difficult‑to‑treat erectile dysfunction Many patients in this study had veno‑occlusive dysfunction, a condition where blood leaks out too quickly to maintain an erection. Medications often don’t work for these men. This combined surgery—venous stripping plus girth enhancement—provides a potential new solution for a group with limited options. 2. It shows strong improvements in erection quality After surgery, patients had significant increases in erectile‑function scores (IIEF‑5 and EHS) compared with before treatment. This means the procedure didn’t just change anatomy—it improved real‑world sexual function. 3. It improves penile girth in a controlled, anatomical way The technique increased both glans diameter and shaft diameter with statistically significant results. This matters because girth enhancement is often controversial, but this method is based on actual fibro‑vascular anatomy, not fillers or unsafe materials. 4. It uses a novel, anatomy‑guided approach The surgery is based on the concept of de novo penile fibro‑vascular assembly, a modern understanding of how penile tissues support blood flow and structure. This represents a shift toward evidence‑based, anatomy‑driven reconstruction. 5. It shows promising long‑term outcomes Patients were followed for up to 10 years, and the improvements were sustained over time. Long‑term data like this are rare in sexual‑medicine surgery. 6. It highlights the need for better recognition of venous‑leak ED All patients in the study had confirmed venous leakage, yet many men with this condition are misdiagnosed or told nothing can be done. This research reinforces that veno‑occlusive dysfunction is real, diagnosable, and treatable.

Perspectives

Clinical Perspective This study highlights that veno‑occlusive dysfunction is a real and treatable cause of erectile dysfunction. The combined procedure improved erection quality and penile stability, offering a meaningful option for patients who do not respond to medication. Surgical Perspective The work demonstrates the value of anatomy‑guided surgery. By stripping leaking veins and reinforcing the tunica albuginea with autologous tissue or Surgiform, surgeons achieved better blood retention and increased penile girth. The long‑term follow‑up strengthens the credibility of the technique. Patient Perspective For patients, the study provides reassurance that both erection restoration and girth enhancement can be achieved safely when based on sound anatomy. The high satisfaction rate (over 80% in one subgroup) shows that the procedure can meaningfully improve quality of life. Research Perspective This work contributes to a growing body of evidence supporting penile fibro‑vascular assembly as a framework for reconstructive surgery. It also highlights the need for larger studies to validate the promising results seen in this 10‑year retrospective cohort. Educational Perspective The study reinforces the importance of understanding penile venous anatomy, recognizing venous leakage, and applying precise surgical technique. It serves as a strong teaching example for trainees learning how to manage complex erectile dysfunction cases.

Dr. Geng Long Hsu

Read the Original

This page is a summary of: Novel strategy for combining penile erection restoration and factual girth enhancement based on de novo penile fibrovascular assembly, European Urology, March 2024, Elsevier,
DOI: 10.1016/s0302-2838(24)00170-2.
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