[Revascularization of the corpora cavernosa in ischemia-induced erectile dysfunction]

Revascularization of the cavernous bodies (CB) has its place in a highly selected patient population as the only causal therapy for erectile dysfunction (ED) and provides an alternative to the implantation of alloplastic erectile aids. The indication for arterialization of the CB is currently only established when conservative treatment has failed. The most important criteria for the intervention are controversial: an age of under 50, an incidence of not more than two classical risk factors for impotence and the exclusion of diabetes mellitus. The leading revascularization procedure in German-speaking countries comprises arteriovenous shunting of the inferior epigastric artery with the dorsal vein and artery of the penis. A retrospective analysis of results is problematic due to the nonuniform indicational criteria, the multiplicity of applied revascularization procedures and a nonstandardized follow-up. Subjective assessment of improved erectility is the sole target criterion in the majority of studies. Therapeutic results range from 33 to 87% with regard to subjective success rates. Attempts to objectify the treatment results were made in only few of the studies and disclosed bypass patency in 44 to 92% one year after the intervention. The conclusions drawn at the last "Consensus Development Conference on Impotence" (CDCI) of the National Institutes of Health (NIH) in Washington have not lost their topicality in view of the great number of still unanswered questions. There the recommendation was made in 1992 to perform penile arterialization only in controlled prospective clinical trials. The European Urological Association (EUA) is currently organizing a Consensus Conference that will provide the framework for prospective studies that can serve as a basis for clarifying the open questions.