Is deep dorsal vein arterialization effective in elderly patients?

Area of Science:

• Urology
• Andrology
• Vascular Surgery

Background:

• Arterialization of the penis is a recognized treatment for erectile dysfunction (ED), primarily in younger patients.
• The efficacy of these procedures in elderly populations, particularly those without common ED risk factors, remains less explored.
• Deep dorsal vein arterialization (DDVA) is a specific surgical technique for penile revascularization.

Purpose of the Study:

• To evaluate the effectiveness of deep dorsal vein arterialization (DDVA) in a cohort of healthy elderly patients diagnosed with erectile dysfunction (ED).
• To assess surgical outcomes using standardized questionnaires in a carefully selected group of older men with ED.

Main Methods:

• Forty-three elderly patients with ED, meticulously screened to exclude risk factors like hypertension, diabetes, and smoking, underwent comprehensive pre-operative assessments.
• These assessments included corpus cavernosum electromyography, cavernosometry, and penile Doppler ultrasonography.
• All patients were treated with DDVA using the Furlow-Fisher technique, with outcomes assessed via the International Index of Erectile Function (IIEF-15) questionnaire, defining success as an IIEF-5 score increase of at least five points.

Main Results:

• The study identified underlying causes of ED in the patients, including caverno-occlusive disease (21), arteriogenic disease (13), and combined conditions (9).
• The mean age was 59.7 years, with a follow-up of 22.1 months. DDVA achieved success in 60.5% of cases (26 patients) based on IIEF-5 criteria.
• Significant improvements were noted in overall IIEF-15 scores (from 19.2 to 28.5) and specific domains (erectile function, intercourse satisfaction, overall satisfaction), irrespective of ED etiology or patient age relative to 60 years.

Conclusions:

• Deep dorsal vein arterialization (DDVA) can be a successful surgical intervention for carefully selected elderly patients with erectile dysfunction (ED).
• The key to successful outcomes appears to be the rigorous exclusion of traditional risk factors for ED prior to surgical consideration.
• The procedure demonstrates potential for improving erectile function and patient satisfaction in this specific demographic.