Microrevascularisation of the penis in vascular impotence

Abstract

Purpose: We evaluated the results of microvascular penile revascularization in impotent men and carefully selected those whose vasculogenic impotence was de®ned as arteriogenic impotence, veno-cavernous leakage or mixed vasculogenic impotence. Materials and methods: Over a period of 11 y, 114 patients were treated for vasculogenic impotence with two surgical procedures: Michal II arterial bypass (44 patients) and modi®ed Furlow±Fisher technique of deep dorsal vein arterialization (DDVA) (70 patients). Initial evaluation included history, physical and neurological examination, hormonal level determination, pharmacological erection test, Rigiscan, duplex ultrasonography, selective pudendal arteriography, dynamic cavernosometry and cavernosography. The patients were followed up for a mean period of 17 months and the results were clinically evaluated. Results: The results at the end of one month were considered as good in 69.5% and improved in 12.2% and failed in 18.3%. Follow-up results are good in 47.8%, improved in 14.6% and failed in 37.4%. The best success rate was obtained with patients with pure venogenic impotence treated with DDVA, whereas the worst was observed in patients with pure arteriogenic impotence treated with the Michal II procedure. DDVA seems to provide better results than arterial bypass regardless of the etiology of impotence. Conclusions: Penile microvascular revascularization is not the best cure for all impotent men but appears to have a place in the treatment for selected patients with vasculogenic impotence. Further studies will be necessary to de®ne parameters able to permit a better understanding and selection of candidates.DDVA is the most effective procedure to treat surgically vasculogenic impotence although the hemodynamic and biologic consequences of this operation are unknown.

Evaluation of penile revascularization for erectile dysfunction: a 10-year follow-up

“…This figure is similar to the short-term results reported in the literature. 4,19,20 Moreover, our data did not show significant differences in the results between the 2-and the 5-y follow-up, indicating that the …”

Penile revascularization surgery for arteriogenic erectile dysfunction: the long‐term efficacy rate calculated by survival analysis

“…The subjectively reported efficacy of penile revascularization surgery is 40-85% [18][19][20][21][22][23][24]. These authors noted that prolonged patency of the anastomosis requires a technically sound procedure and that the afferent epigastric artery must not be kinked but linear.…”

Surgical niche for the treatment of erectile dysfunction

“…Penile vascularization surgery might potentially invite hyperesthesia of the glans and devastating spongy necrosis. Other complications include loss of penile length (28%), decreased penile sensitivity (24.7%), wound hematoma (7.8–25%), sepsis (3.5%), inguinal hernias (2.8%), wound infection (2.8%) and urinary tract infection (2.6%) . Trauma to the dorsal nerve might jeopardize penile sensation, which can be obviated by utilizing an operating microscope for microvascular dissection .…”

“…Dorsal vein arterializations, IEA‐to‐DDV anastomosis, can be complicated with hyperemia of the glans, provoking ulcers of the skin, penile pain and compression of urethra. Glanular hyperemia accounts for 4–21% of patients receiving the surgery, and shows a disastrous complexity that requires surgical intervention in many cases . To ward off overperfusion of the glans penis, ligation of all the contributing veins and venules distal to the site for IEA–DDV anastomosis is warranted.…”