INTRODUCTION

Erectile dysfunction (ED) is found in all societies and affects many males throughout the world. For many patients, unfortunately, it does not attenuate after the availability of these great agents of phosphodiesterase-5 inhibitors including sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) although their introductions are absolutely important medical events. Not surprisingly the way to solve ED is still underdeveloped. Nevertheless we state categorically that the most likely curable and sustainable solution for most ED patients is ready and available via microsurgeries. They are auditable as well as reproducible although these methods are challenging.

We began to apply pure local anesthesia on an out-patient basis successfully, in penile implants, in 1987. A similar technique was derived and extended to other type of penile surgeries afterwards. A successful international businessman had been bothered by erectile dysfunction for seven years and had already consulted many credible physicians with consistent recommendations of penile implantation. Amazingly, his prolonged condition was corrected by venous stripping surgery and high ligation of both internal spermatic veins, under local anesthesia, on an outpatient basis, and he was able to fly out the following day. It was amazing to the physician who took care of the wound subsequently. We found that local anesthesia is suitable not only for this procedure but also for other types of penile operations, including penile implant surgery of every type. By then, a pure local anesthesia with true outpatient basis, has been unexceptionally and consistently applied. Interestingly this feasible and sustainable kind of method is overwhelmingly welcomed in our modern society.

We have developed and have performed over 3000 cases of penile venous stripping surgery since June 1986, with and without venous grafting for morphologic correction, without exception, under local anesthesia, and on an out-patient basis. We are able to complete this operation in less than 6 hours. Likewise, penile prosthesis implants, performed already on 173 patients, and curvature correction procedures, performed already in 595 cases, can also be completed within a similar time frame. As a result, patients are able to receive treatment on impotence and enjoy sightseeing during the same period. We have focused our interest on and have explored this field since 1985.

Although Wooten first published ligation of the deep dorsal vein for atonic impotence in Texas medical Journal in 1902, the general consensus from these procedures was early success with few durable cures and this surgery is almost abandoned since the clinical guidelines panel of the American Urological Association had declared that venous and arterial surgery were not justified in routine use in 1996. Accordingly, the fact that the venous factor was previously accepted worldwide, and that it has since been eliminated, have led us to explore this method which has brought us promising results, a 90.9% success rate in which experience at least 3 points increment of IIEF-5 (25 in total) scores post-operatively after new insight into penile venous and muscular anatomy which was elucidated in 2001. Thus, on the contrary, penile venous stripping surgery should not be discontinued since once an ED man restores his annoying impotence, eventually a true rejuvenation always comes over him although it is very challenging. Furthermore, amazingly, they can undergo this surgery and enjoy sightseeing simultaneously because of a pure local anesthesia. It is resulted from recent advancements in penile anatomy and erection hemodynamic research with which to contribute to the solutions for male impotence. Such solutions have been proven in clinical applications by us through our dedication to research, experiment and clinical services via refined microsurgical procedures.

We are recommending our type of surgery in which neither a Bovie nor a suction apparatus is necessary. Local anesthesia on a true outpatient basis has been unexceptionally used since 1986 after repeated cadaveric studies and microsurgical training were conducted on a small rat. Furthermore, we are very gratified with the results of our variety of procedures, and with the benefits which have brought to our patients who suffered from impotence and whose condition was not correctable through other attempts of surgery or finding no relief from the pharmaceutically based treatments available today. It is our hope that these procedures and their techniques will be available world-wide.

We would request of any physician who is interested in this field to take the time to do the necessary research on this procedure. Let no physician rush to a hasty decision which will deprive afflicted patients of the greatly sought and long yearned for ED solution.

For Our Dear Colleagues:
If you are an urologist, a vascular surgeon or a plastic surgeon with a good command of a micro-surgical technique, and are interested in this field, you are welcome to take a meticulous look at and make a careful examination of these operations. We offer a well-equipped laboratory, staffed with professionals who surpass the pre-requisite technical skills in micro-surgical drills. You are always welcome to participate in any of the operations.

During the practice of micro-surgery, a fresh leaf, surgical gloves, and then live rats, are good objects. The testicular auto-transplantation of a rat is the most difficult phase, because of its anatomical complexity and the tiny size of the tissue. It is, however, an excellent organ for psychological tolerance and for tissue-layer recognition, and is very helpful when performing surgery on a patient, since the surgeon can image his visual acuity to a 25-times magnification when using one’s naked eyes or just a loupe.

We reiterate, stress and emphasize that any vascular surgeon, urologist, plastic surgeon or any one interested in this field, is welcome to take a meticulous look at and make a careful examination of these operations at our hospital or any designated hospital. We are asking for the opportunity of being examined. The surgery on your patients is warmly welcomed since it would be convenient for you to follow and audit the outcome.

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