[Impotence in a urologic service]

In a recent experience we have studied 297 patients for impotence. 102 were considered psychogenic and 195 organic; 105 of the latter had isolated or associated arterial or venous lesions. The remaining 81 patients had preponderant organic pathology: Peyronie's disease, neurological disease, diabetes and pelvic trauma. All patients were explored by NPT (nocturnal penile tumescence), Doppler examination, intra-cavernous papaverine test, angiography and erectile flow associated with cavernography. We report our microvascular surgery results from the last seven years. 80 reconstructive vascular procedures were performed on a population of patients who averaged 50 years of age. 50 epigastric-cavernous by-passes were performed. Complete recovery has been observed in 14% with an average of 42 months follow-up. Erection improvement with possibility of vaginal intromission in 58%. Immediate or secondary thrombosis and priapism in 28%. 21 arterial epigastric-dorsal unilateral by-passes were performed with an average follow-up of 20 months. In 11 cases the arterial micro-revascularization was associated with deep dorsal vein ligature. Results are as follows: 10 excellent, 4 significant improvement, 3 failures and too short follow-up in three. 9 isolated venous ligature with a mean follow-up of 15 months. Complete recovery was observed in 3 patients, improvement in 3 and failure in 2. The author emphasizes the interest of a better selection of surgical indications, improvement of microsurgical techniques with epigastric-dorsal anastomosis associated with postoperative anticoagulant therapy whenever possible.