Erectile function before and after reconstructive arterial surgery in men with occlusive arterial leg disease

Erectile impotence is a well-known complication of vascular surgery in the aorto-iliac area. So far the pathogenesis has not quite been understood, but peroperative damage to the autonomous nerves has been suggested. Ninety-eight men with arterial insufficiency in their legs underwent an additional sexual evaluation including penile blood pressure measurement and cystometric examination. The arterial insufficiency necessitated arterial reconstruction involving aorta or the common iliac arteries in 28 patients. When possible, improvement of the penile blood supply was aimed at during the operation, but no nerve-sparing techniques were employed. The seven potent patients remained potent, while nine patients became potent after the operation. The cases remaining impotent after the operation could all be explained considering the arteriography, the operation and the changes in penile blood pressure. The erectile function is related to the condition of the penile blood supply and it may be possible to reduce the rate of postoperative impotence by considering the penile blood supply when planning the operative strategy.