Vascular surgery in the treatment of impotence; its present possibilities and prospects

Five years ago we reported on a technique of direct arterial anastomosis with the cavernous bodies of the penis. At that time we expressed the hypothesis that in some cases impotence could be the result of organic changes in the arterial bed supplying the cavernous bodies. A histological study was therefore performed on postmortem material and a new arteriographic technique - phalloarteriography - was developed to visualize the internal pudendal artery, the penile artery and its branches. Bilateral examination carried out in 132 patients with erectile impotence established stenosis or occlusion of these arteries or aplasia of the deep penile artery in most of them. Stenoses or occlusions were either of traumatic (after pelvic fracture) or sclerotic origin in middle aged and older patients or were related to diabetes. In more than 20% of patients with occlusions in the arterial bed plastic induration of the penis (Peyronie's disease) was found. Phalloarteriography has become the basic technique of surgical indication and approach. Revascularization procedures consisted of anastomosis of the inferior epigastric artery to the dorsal penile artery or directly to the cavernous bodies. The results attained in the first 54 patients confirmed the vasculogenic origin of their impotence. The development of phalloarteriography and revascularization procedures contribute to surgical management of impotence and extend the use of vascular surgery.