January 20, 2012
New research suggests that penile revascularization surgery may offer an effective alternative to phosphodiesterase type 5 inhibitors in the treatment of men with vasculogenic erectile dysfunction (ED). Efficacy of surgery was evaluated in 110 men who underwent penile revascularization between 1999 and 2010 and were followed up for a mean of 73.2 months. There was an increase in the mean International Index of Erectile Function (IIEF-5) score postoperatively (7.3 vs. 16.8). Success rates (a 5 point or greater increase in the IIEF-5 score) were evaluated at 3 months, 1 year, 2 years, 3 years and 5 years postsurgery in men who achieved a no-ED threshold score of > 26 in the IIEF-5, and were 81.8, 72.7, 70, 66.3 and 63.6%, respectively. The highest success rates were observed among men with no risk factors (92.8%) (Kayigil, O. et al. BJU Int 2011, 109: 109).
What is Penile Revascularization Surgery?
Also known as microvascular arterial bypass surgery for impotence
Penile revascularization surgery is similar to a cardiac bypass, but in the penis. It is for healthy men less than 50 years old with no evidence of a venous leak upon testing. The most common causes of erectile dysfunction which can be treated by penile revascularization are blunt trauma to the perineum or bike riding.
This procedure is highly specialized and requires extensive training in microvascular surgery as well as special equipment in the OR. Physicians at the Center for Sexual Medicine have performed more than 700 revascularization procedures over the last 20 years.
Most ideal candidates are young men with a history of perineal or pelvic trauma in whom arteriography reveals a localized common penile artery lesion.
Those with generalized vascular pathology are poor candidates for this operation as the same disease will likely affect the revascularized segment in the years following surgery.
Revascdularization is achieved by microsurgical anastomosis of the inferior epigastric artery to the dorsal penile artery.
The donor artery is carefully dissected from its origin at the femoral artery to a more distal point near the umblicus where it is transected.
The cut artery is then brought through the inguinal ring into the scrotum for microvascular anastomosis to the right or left dorsal artery.
Adherence to strict patient selection criteria will yield excellent longterm patency and patient satisfaction results.