Microsurgical arterio-arterial and arterio-venous penile revascularization in patients with pure arteriogenic impotence

Objective To restore physiological erection by performing microsurgical penile revascularization. Patients and methods The records of 21 patients with pure arteriogenic impotence were reviewed. Thirteen patients with localized obstruction of the internal pudendal or common penile artery underwent a Michal II arterio-arterial penile revascularization. Eight patients with a more distal arterial obstruction underwent a penile deep dorsal vein arterialization (DDVA). The mean follow-up period was 22 months. Surgery was considered successful when the patients had a permeable anastomosis and were able to achieve satisfactory erections resulting in normal intercourse. Results Potency was restored in eight of the 13 patients who had a Michal II procedure and in five of the eight patients who had a DDVA. Under antithrombotic therapy graft occlusion occurred in four patients. Conclusion Microsurgical penile revascularization restored erectile function in two-thirds of patients in this study. However, further research must be performed to reach a greater understanding of the revascularization process.