Long-term results of arterial bypass surgery for impotence secondary to segmental vascular disease

We evaluated the long-term results of arterial bypass surgery in impotent men carefully selected for nonatherosclerotic arterial vascular disease.

During a 7-year period only 11 of 1,352 impotent men (0.8%) were selected as ideal candidates for arterial vascular surgery. Initial evaluation included history, physical examination and a screening pharmacological erection test. Duplex ultrasonography was performed in patients who failed to respond adequately to pharmacological stimulation and were believed to be potential candidates for vascular surgery. Further evaluation included formal nocturnal sleep laboratory testing, dynamic infusion cavernosometry and arteriography. Dorsal artery bypass was performed in 9 patients and arterialization of the deep dorsal vein was done in 2.

Average followup was 50 months (range 12 to 84). Initial followup duplex ultrasonography revealed a significant increase in cavernous artery peak systolic blood flow velocity (p < 0.001) and patent arterial anastomoses in all but 1 patient. The initial success rate without supplemental injection therapy was 82% and the final success rate was 64%. Even with long-term followup, 91% of the patients were improved from baseline, and were sexually active with (27%) or without (64%) injection therapy.

Arterial bypass surgery can be successful in select impotent patients without generalized atherosclerosis or other risk factors for impotence. Further refinement of screening parameters may improve patient selection and long-term results of vascular surgery.