title: Outcome of penile revascularization for arteriogenic erectile dysfunction after pelvic fracture urethral injuries.
abstract: OBJECTIVE
  To review our experience with penile revascularization for patients with bilateral occlusion of the deep internal pudendal arteries after pelvic fracture urethral injury (PFUI).
  
  
  METHODS
  We identified 17 patients who had undergone penile revascularization with end-to-side anastomosis of the deep inferior epigastric artery to the dorsal penile artery from July 1991 to December 2010. Success was defined as achieving erections sufficient for intercourse with or without pharmacologic assistance.
  
  
  RESULTS
  All patients had had a PFUI causing arterial insufficiency and erectile dysfunction not responsive to pharmacologic intervention. Of the 17 patients, 4 (24%) underwent revascularization before and 13 (76%) after PFUI repair. The mean age at revascularization was 32.7 years (range 17-54). At an average follow-up of 3.1 years, the surgery was successful in 14 of the 17 patients (82%). In patients with erectile dysfunction as an indication for surgery, successful erections were achieved in 11 of 13. For those who underwent revascularization to prevent ischemic stenosis of the urethral repair, 3 of 4 achieved successful erections, and all subsequent urethral surgeries were successful. The penile duplex ultrasound parameters showed clinically and statistically significant improvements after revascularization. No operative complications developed. The average hospital length of stay was 4.7 days. Four patients experienced early postoperative complications, including an abdominal wall hematoma requiring evacuation in one, penile edema in two, and a superficial surgical site infection in one. No late complications occurred.
  
  
  CONCLUSIONS
  Penile arterial revascularization in select patients can allow for successful treatment of PFUIs and the refractory erectile dysfunction caused by them.
authors.affiliation: Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia 23502, USA.
authors.forename: Jack M
authors.initials: JM
authors.lastname: Zuckerman
authors.forename: Kurt A
authors.initials: KA
authors.lastname: McCammon
authors.forename: Britton E
authors.initials: BE
authors.lastname: Tisdale
authors.forename: Larry
authors.initials: L
authors.lastname: Colen
authors.forename: Ted
authors.initials: T
authors.lastname: Uroskie
authors.forename: Paul
authors.initials: P
authors.lastname: McAdams
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Jordan
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000601:surgery*; D019074:Epigastric Arteries / Q000601:surgery; D006801:Humans; D018783:Impotence, Vasculogenic; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply* / Q000293:injuries*; D012189:Retrospective Studies; D012421:Rupture; D014521:Urethra / Q000293:injuries*; D055815:Young Adult