[Results of micro(vascular) surgical interventions in vascular-induced disorders of erection]

In 71 patients aged 20 to 65 years who suffered from erectile dysfunction of vascular (mainly arterial and venous) origin, we performed 66 microsurgical vascular reconstructions (12 according to Michal II, 42 using Virag I, 5 using the Hauri modification and 7 according to the author's own method) and 5 operations to reduce venous outflow from the corpora cavernosa. In addition, 6 Virag I redo reconstructions and other secondary interventions in 18 cases were performed as well as (semi-)conservative therapeutic measures were undertaken. Over a mean follow-up period of 35.1 months 46 out of 56 men were again able to have adequate to normal sexual intercourse. The other patients showed only minimal improvement or their condition remained unchanged. No patient's condition was seen to worsen. The main complications were occlusions of the reconstruction and the hypervascularization syndrome of the penis, affecting 13.3% of the arterio-venous anastomoses. This complication, which often occurred many months postoperatively, was always overcome with banding and in some cases by additional venous ligatures so that a functional reconstruction remained in all but one case. In cases of erectile dysfunction of vascular origin, vascular surgery presents the most natural form of therapy and therefore deserves consideration before life-long auto-injection therapy is prescribed for the corpora cavernosa or the implantation of a penis prosthesis is considered. Specific angiological investigation is advisable in all cases in which a four- to six-month course of (semi-)conservative treatment does not bring long-term success.