LONG-TERM RESULTS OF ARTERIAL BYPASS-SURGERY FOR IMPOTENCE SECONDARY TO SEGMENTAL VASCULAR-DISEASE

Purpose: We evaluated the long-term results of arterial bypass surgery in impotent men carefully selected for nonatherosclerotic arterial va scular disease. Materials and Methods: During a 7-year period only 11 of 1,352 impotent men (0.8%) were selected as ideal candidates for art erial vascular surgery. Initial evaluation included history, physical examination and a screening pharmacological erection test. Duplex ultr asonography was performed in patients who failed to respond adequately to pharmacological stimulation and were believed to be potential cand idates for vascular surgery. Further evaluation included formal noctur nal sleep laboratory testing, dynamic infusion cavernosometry and arte riography. Dorsal artery bypass was performed in 9 patients and arteri alization of the deep dorsal vein was done in 2. Results: Average foll owup was 50 months (range 12 to 84). Initial followup duplex ultrasono graphy revealed a significant increase in cavernous artery peak systol ic blood flow velocity (p <0.001) and patent arterial anastomoses in a ll but 1 patient. The initial success rate without supplemental inject ion therapy was 82% and the final success rate was 64%. Even with long -term followup, 91% of the patients were improved from baseline, and w ere sexually active with (27%) or without (64%) injection therapy. Con clusions: Arterial bypass surgery can be successful in select impotent patients without generalized atherosclerosis or other risk factors fo r impotence. Further refinement of screening parameters may improve pa tient selection and long-term results of vascular surgery.