Traumatic vasculogenic erectile dysfunction: role of penile microarterial bypass surgery

Penile microarterial bypass surgery (MABS) may be the only treatment capable of restoring normal erectile function without 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 has resulted in this surgery being considered experimental. In addition, poor reimbursements, long surgical time, and the need for microsurgical expertise have lead to infrequent penile revascularization procedures. Using the criteria for the Arterial Occlusive Disease Index patient, only 4 of 31 manuscripts met the criteria. The total studied population of these four publications was 50, which was considered too small to determine if MABS is effective or not. Reported successful outcomes were 36% to 91%. We recently published the largest long-term outcome MABS study using validated instruments. We documented MABS provides long-term improvements in erectile function, depression, and overall satisfaction in well-selected patients. The Members of the Erectile Dysfunction Guideline Update Panel consider: "Arterial reconstructive surgery is a treatment option only in healthy individuals with recently acquired erectile dysfunction secondary to a focal arterial occlusion and in the absence of any evidence of generalized vascular disease."