Microrevascularisation of the penis in vascular impotence.

Abstract

We evaluated the results of microvascular penile revascularization in impotent men and carefully selected those whose vasculogenic impotence was defined as arteriogenic impotence, veno-cavernous leakage or mixed vasculogenic impotence. Over a period of 11 y, 114 patients were treated for vasculogenic impotence with two surgical procedures: Michal II arterial bypass (44 patients) and modified 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 arteriograpy, dynamic cavernosometry and cavernosography. The patients were followed up for a mean period of 17 months and the results were clinically evaluated. 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. 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 define 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.