The Place of Surgery for Vascular Impotence in the Third Millennium

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Abstract
Purpose: With the arrival of new oral therapies the question arises about the role of surgery in patients with vascular impotence. We compared the sexual satisfaction rate in patients with arterial and/or venous impotence treated with 4 surgical techniques with long-term followup. Materials and Methods: Surgery was performed in 130 patients with vascular erectile dysfunction by 1 surgeon. Two young patients (2%) with traumatic arterial lesions underwent penile revascularization (group 1), while 128 with arterial and/or venous impotence were also treated with surgery, including 11 of 130 (8%) with deep dorsal penile vein resection (group 2), 39 (30%) with arterialization of the deep dorsal penile vein (group 3) and 78 (60%) with penile implants (group 4). Sexual satisfaction, defined as the possibility of satisfactory sexual intercourse without any additional treatment or pain, was evaluated by patient interview. Results: Of the 130 patients 111 (85%) participated in the sexual life events interview, including 2 of 2 (100%) in group 1, 7 of 11 (63.6%) in group 2, 33 of 39 (85%) in group 3 and 69 of 78 (88%) in group 4. Mean followup was 50, 48, 46 and 54 months for groups 1 to 4, respectively. The sexual satisfaction rate was 2 of 2 (100%) for penile revascularization, 1 of 7 (14%) for venous resection, 4 of 33 (12%) for arterialization and 64 of 69 (93%) for penile implantation. Complications occurred in 9.5%, 12.5% and 20.5% of the patients in groups 2 to 4, respectively. Conclusions: Except for young patients with traumatic arterial lesions this study demonstrated the poor sexual satisfaction rate in impotent patients treated with the vasculogenic approach and the high rate of satisfaction in those treated with penile implants. Better selection criteria must be applied for vascular surgical treatment for impotence.

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