Patient selection criteria in the surgical treatment of veno-occlusive dysfunction

Purpose: We evaluated short and long-term results of simple and complex ven ous surgery in patients with veno-occlusive dysfunction unresponsive to max imum recommended doses of intracavernous alprostadil, who were selected wit h newly developed diagnostic indicators. Materials and Methods: A total of 23 impotent men with a mean age of 41 yea rs (range 20 to 50) underwent complex penile venous surgery. Only patients fulfilling at least 3 criteria were included in study. The criteria were mi ld cavernous leak assessed by cavernosometry (grades 1 and 2), more than 30 % cavernous smooth muscle tissue (histomorphometric analysis), normal analo gical corpus cavernosum electromyography recordings according to internatio nal standards, cavernosal oxygen tension greater than 65 mm. Kg at erection and age younger than 50 years. Results: Of 23 patients 17 (74%) had normal erections within a year after s urgery, and 5 of them (29%) complained of recurrent erectile dysfunction. A t long-term followup 6 of 12 patients had spontaneous erections. Conclusions: Careful selection with advanced diagnostic techniques should b e mandatory before performing venous surgery in patients with high degree v eno-occlusive dysfunction as the only alternatives are major therapeutical solutions.