LAPAROSCOPICALLY ASSISTED PENILE REVASCULARIZATION FOR VASCULOGENIC IMPOTENCE - 2 ADDITIONAL CASES

Purpose: Microsurgical revascularization of the penis in vasculogenic impotence is an accepted surgical procedure in young men with a histor y of blunt pelvic or perineal trauma. Most penile revascularization te chniques use the inferior epigastric artery in direct artery-to-artery revascularization or dorsal vein arterialization procedures. To obvia te the wide pararectal incision laparoscopic mobilization of the infer ior epigastric vessels has been recently proposed. We present 2 cases of successful laparoscopically assisted penile revascularization. Mate rials and Methods: With the patient under general anesthesia the first trocar was inserted in the umbilical region and pneumoperitoneum was induced. Two other trocars were positioned laterally. As soon as the i nferior epigastric vessels were accessed, dissection was initiated bel ow the level of the arcuate line. The vessels were dissected cephalad en bloc to a point of bifurcation of the inferior epigastric artery ab ove the umbilical level. The inferior epigastric pedicle was ligated w ith clips and transected at the cephalad edge of the dissection. It wa s then mobilized and tunneled through an infrapubic incision at the ba se of the penis for subsequent microvascular anastomosis with the peni le vessels. Results: The anastomosis was patent and hemostasis was sat isfactory. Operative time in the 2 cases was 4.3 and 5.2 hours, respec tively. At 3 months both patients reported complete erections. Conclus ions: Our experience confirms the extremely practical use of laparosco py which, due to its magnification power, makes it possible to perform fast, accurate excision of the epigastric bundle. Moreover, a wide pa rarectal incision, which is a frequent cause of postoperative complica tions, is avoided.