Long-term followup and selection criteria for penile revascularization in erectile failure.
OBJECTIVE
We report the long-term results of penile revascularization surgery for erectile failure and suggest possible selection criteria for this controversial surgical procedure.


METHODS
In 7 years 62 impotent men who did not respond to pharmacotherapy underwent microsurgical penile revascularization and completed long-term followup evaluation in 41 months (range 18 to greater than 62) consisting of a detailed questionnaire, duplex sonography and optional pharmacotherapy or angiography. The Virag procedure was chosen for the first 7 patients, the original Hauri technique for the next 13 and the modified Mannheim triple anastomosis for 42.


RESULTS
Of all patients 34% achieved spontaneous and another 20% pharmacologically induced erections. Success in diabetics and older patients was lower (43% for diabetics, 39% for those older than 50 years at surgery), while it was high in men with less than 2 risk factors (58%) as well as in younger patients (69% for those up to 50 years old). Shunt patency was 92%. Complications such as glans hyperemia developed in 13% of patients, shunt thrombosis in 8% and inguinal hernias in 6.5%.


CONCLUSIONS
Patient selection is vital for the successful outcome of penile revascularization surgery. We adhere to strict selection criteria, such as patient age maximum of 50 years, less than 2 risk factors, no recent diabetes and termination of nicotine abuse. Penile revascularization surgery is highly indicated in this group of patients, especially since it is the only causal therapy for erectile failure.
Department of Urology, Klinikum Mannheim of the University of Heidelberg, Mannheim, Germany.
M
M
Manning
K P
KP
Jünemann
J R
JR
Scheepe
P
P
Braun
A
A
Krautschick
P
P
Alken
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005500:Follow-Up Studies; D006801:Humans; D018783:Impotence, Vasculogenic / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply* / Q000601:surgery*; D013997:Time Factors