[Experiences up to now with diagnosis and microsurgical revascularization in disorders of erection]

Nine patients with impaired erection and a mean age of 41 years were diagnosed by means of a battery of multidisciplinary examinations: specific anamnesis, urological, neurological, endocrinological, angiological, psychosomatic and metabolic investigations, electromyography, measurement of the latency period and duration of the bulbocavernosus reflex, measurement of the nocturnal penis tumescence, penile blood-pressure index (PBPI), artificial erection with papaverine, flowmetry, phalloarteriography, dynamic cavernosonography. In all cases, an arterial and/or venous genesis was discovered as well as neurological or psychological factors. Three microsurgical techniques were employed: the end-to-side anastomosis of the A. epigastrica inferior preferably with the A. dorsalis penis (two cases), with the V. dorsalis penis profunda (four cases) and with the two combined (three cases). In the last cases, the vein was ligated or constricted proximal to the anastomosis. The primary factor in choosing the particular reconstruction method was the angiogram. Diagnosis entailed no complications for the patients. In addition to minor postoperative complications such as a hematoma, scar pains or hypervascularization of the glans and the corpus spongiosum, three early occlusions occurred in reconstructions up to one month postoperatively. One to five months after surgery the erectile potency had improved or normalized in seven out of nine patients, making intercourse possible. Two patients, the only two with a posttraumatic interruption in the bulbocavernosus reflex curve, showed no change. For purposes of postoperative control of arterio-venous anastomoses, the typical shunt sound is observed by stethoscope. After revascularization of the A. dorsalis penis, it is recommended that the PBPI be taken at the Aa. profundae penis and, when necessary, that a control angiography be performed. For the treatment of potency disturbances stemming from vascular causes, our results advocate that microsurgical vascular reconstruction be given due consideration before implantation of a penile prosthesis.