title: Microvascular arterial bypass surgery: long-term outcomes using validated instruments.
abstract: OBJECTIVE
  Penile microarterial bypass surgery may be the only treatment capable of restoring normal erectile function without the necessity of chronic use of vasoactive medications or placement of a penile prosthesis. Lack of standardization in patient selection, hemodynamic evaluation, surgical technique and limited long-term outcome data using validated instruments have resulted in this surgery being considered experimental. In this study we report long-term outcome data using validated questionnaires in young men (younger than 55 years) free of vascular risk factors who underwent microvascular arterial bypass surgery.
  
  
  METHODS
  This is a single institution retrospective institutional review board approved study of 71 men (mean age 30.5 +/- 9.2 years) who underwent microvascular arterial bypass surgery between 1996 and 2007 (mean followup 34.5 +/- 18 months).
  
  
  RESULTS
  Mean preoperative and postoperative penile rigidity measures with and without phosphodiesterase type 5 inhibitors were 41%, 77% and 71%, 90.8%, respectively. Mean total International Index of Erectile Function score, Erectile Function domain, and question 3 and 4 scores preoperatively and postoperatively were 35.5 +/- 14.8, 13.7 +/- 6.7, 2.2 +/- 1.4 and 2.1 +/- 1.3, and 56.2 +/- 16.6, 23.8 +/- 6.6, 4.1 +/- 1.4 and 3.9 +/- 1.5, respectively. Preoperative and postoperative Center for Epidemiologic Studies Depression Scale scores were 42.0 +/- 10.0 and 33.7 +/- 6.1. Treatment satisfaction according to the Erectile Dysfunction Inventory of Treatment Satisfaction was high. All differences were statistically significant. Short-term complications included emesis (2 of 71), dysuria (5 of 71) and wound infection (2 of 71). Long-term complications were loss of penile length (20 of 71) and decreased penile sensation (18 of 71). There were no cases of prolonged penile pain or glans hyperemia.
  
  
  CONCLUSIONS
  In patients with no vascular risk factors and pure cavernous arterial insufficiency, microvascular arterial bypass surgery provides long-term improvements in erectile function, depression and overall satisfaction.
authors.affiliation: Center for Sexual Medicine, Department of Urology, Boston University School of Medicine, Boston, Massachusetts 02118, USA. munarriz@bu.edu
authors.forename: Ricardo
authors.initials: R
authors.lastname: Munarriz
authors.forename: Jayant
authors.initials: J
authors.lastname: Uberoi
authors.forename: Gemma
authors.initials: G
authors.lastname: Fantini
authors.forename: Daniel
authors.initials: D
authors.lastname: Martinez
authors.forename: Chester
authors.initials: C
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D001158:Arteries / Q000601:surgery; D007172:Erectile Dysfunction / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply* / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult