Penile Revascularization

Penile Revascularization

Penile revascularization, also known as microvascular arterial bypass surgery for impotence, is similar to cardiac bypass, but the procedure is performed in the penis. Surgeons typically perform penile revascularization on men younger than 50 whose erectile dysfunction is caused by blunt trauma to the pelvic/perineal region and who have no evidence of a venous leak.

Am I a Candidate for Penile Revascularization?

To determine if a man is a candidate for penile revascularization, clinicians can use several tools. One is an arteriogram, an imaging test that uses x-rays and a dye to view the arteries. Candidates for penile revascularization will have a lesion in the penile artery, which partially or totally blocks arterial blood flow in the penis and results in erectile dysfunction. Another test measures perfusion pressure of the penis and in the arm, which ideally should be the same. Lower pressure in the penis indicates blockage. Duplex Doppler ultrasonography is also used to diagnose circulation abnormalities.

Penile Revascularization Procedure

Once the clinician has identified the blockage, it can be bypassed using an artery harvested from the patient himself during the surgical procedure. The donor blood vessel and microvascular surgical techniques are used to restore blood flow to the penis. Penile revascularization is performed under general anesthesia, requires two incisions, and generally takes about five hours. The procedure has also been done using robotic surgery, which requires one incision at the base of the penis. This latter procedure has been performed at Tulane Health Sciences Center in New Orleans and is not yet widely available. (Raynor 2010) Patients who undergo penile revascularization typically must stay overnight in the hospital.

Does Penile Revascularization Work?

A meta-analysis of 25 studies on comparison of penile revascularization was published in 2009. The reviewers found that the success rate of penile revascularization depended on several risk factors, including the patient’s age, smoking, use of alcohol, obesity, high cholesterol, high blood pressure, diabetes, the surgical technique, and the surgeon’s expertise. Among the main reasons the surgery was not successful was the presence of smoking, diabetes, high blood pressure, high cholesterol, coronary heart disease, alcoholism, obesity, and cavernosal fibrosis (abnormal fibrous tissue in the erectile tissue of the penis). In this review, the authors reported about a 50 percent success rate after an average follow-up of 50 months, and long-term failure in about 50 percent of men. (Babaei 2009)

Side Effects of Penile Revascularization

Complications of penile revascularization may include uncontrolled arterial bleeding from blunt trauma (e.g., accidents, sexual intercourse, masturbation) during the first few postoperative weeks. Sexual intercourse should not be resumed for at least six weeks after the procedure. Other complications may include penile pain, reduce penile sensation, priapism (erection lasting 4 hours or more), hyperemia of the glans (blood accumulation in the glans), and slight reduction in penile length. (Babaei 2009; Goldstein) Ideal candidates for penile revascularization are men younger than 30 who have no risk factors (e.g., obesity, smoking, etc.).

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References

Babaei AR et al. Penile revascularization for erectile dysfunction. Urol J 2009; 6(1): 1-7

Goldstein: http://www.sexualmed.org/index.cfm/sexual-health-treatments/for-men/penile-revascularization/

Raynor MC et al. Robot-assisted vessel harvesting for penile revascularization. J Sex Med 2010 Jan; 7 (1 Pt 1): 293-97