Lack of erection capacity
Management of Erectile Dysfunction
In patients with significant vascular abnormalities, treatment may require surgical treatment. Arterial revascularization can be effective in selected patients who are less than 40 years of age, non-smokers and with documented traumatic abnormality.
In these patients, Doppler ultrasound and arteriography must demonstrate a normal vascular tree with localized obstructive arterial lesions. Revascularization is performed using the inferior epigastric artery that is dissected free from the underside from one or both rectus muscles and transferred to the base of the penis.
Microvascular surgical anastomosis is carried out between the inferior epigastric artery and the deep dorsal artery of the penis in an end-to-end or end-to-side fashion. This technique redirects blood from the inferior epigastric artery to the central cavernosal artery and may be effective in as many as 65% of carefully selected patients. Long term data are not currently available to establish the ultimate effectiveness of this treatment modality and it should be limited to centers with significant experience in the diagnosis and treatment of these patients.
with vascular disease, hypercholesterolemia, hypertension or smoking are
not candidates for arterial revascularization.
Sustained surgical success has been identified in less than 40% of patients with an additional 40% of patients responding to a combination of surgery and injectable agent.
Postoperative complications including
penile shortening, decreased penile sensation, recurrent veno-occlusive
incompetence and wound infection and inadequate success rates have limited
this surgical option for most patients. Preferred treatments for
veno-occlusive abnormalities include oral agents such as sildenafil,
intracavernosal injection therapy, vacuum constriction device or penile
Patient partner satisfaction is usually quite high and is higher than many other forms of treatment for ED.
Many types of penile prosthesis are available
classified as either semi-rigid or inflatable. These implants provide
satisfactory penile rigidity, normal sensation, erectile size and
excellent patient partner satisfaction. Patients should be offered penile
prothesis if simpler, less invasive alternatives are inadequate, not well
tolerated or contraindicated. Prior to surgery, a careful discussion about
the implantation procedure, outcomes, complications and caveats should be
held with the patient and partner.