The role of vascular surgery in arteriogenic and combined arteriogenic and venogenic impotence.
Currently, the only procedure that may be ready for clinical application in arteriogenic impotence is the retrograde revascularization operation for patients who have been shown to have localized obstruction of the internal pudendal artery. This applies almost exclusively to young healthy men with impotence due to pelvic trauma. The concept that perineal trauma causes localized obstruction of the penile artery is controversial. Because the best candidates for penile revascularization are young healthy men with localized, rather than diffuse, arterial pathology and with the absence of vascular risk factors, the overall role for treatment of arteriogenic or combined arteriogenic and venogenic impotence by penile revascularization is very limited. For patients with impotence following pelvic and possibly perineal trauma, as well as occasional patients with arteriosclerosis who wish to be considered for penile revascularization, evaluation should begin with screening intracavernous pharmacodiagnosis using papaverine with or without phentolamine, or prostaglandin E1. If a poor response occurs, identification of venous pathophysiology by cavernosometry and identification of arterial pathophysiology by dynamic infusion cavernosometry and/or duplex sonography of the corpus cavernosum should be undertaken. If there is no venous pathology, penile arteriography must be done to design an anatomically rational revascularization operation. In the future, improved results of penile vascular surgery may occur if we can develop a clearer understanding of the physiology and pathophysiology of erection, improved diagnostic techniques, and a better selection of surgical candidates.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Urology, University of California, San Francisco.
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Sharlip
D007172:Erectile Dysfunction / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008722:Methods; D014652:Vascular Diseases / Q000150:complications* / Q000175:diagnosis