[Impotence following stripping]

Among the iatrogenic complications of the surgery of varicose veins, the author has encountered several cases of impotence following stripping of the internal saphenous. Without rejecting the possibility of a psychogenic impotence due to the operation itself, he raises the question of the possible mechanism of this complication. Alter considering the vascularization of the erectile body and the haemodynamic process of erection, he reviews the arterial and venous causes of impotence and sets out the hypothesis which he feels to be the most plausible. Under the arch of the internal saphenous passes the external pudendal artery; injury to this does not usually produce any significant damage, since the erectile body of the penis is vascularized by the internal pudendal artery. But if as a result of a congenital anomaly of the internal pudendal, the supply derives from the external pudendal, ablation of the latter, sometimes carried out by surgeons in the course of ligature of the arch of the internal saphenous vein, could explain this complication. If this hypothesis proves correct, it would be necessary to require surgeons to touch the external pudendal artery in order to avoid this complication, which though exceedingly rare, is psychologically traumatic.