SURGICAL-MANAGEMENT OF IMPOTENCE

Impotence affects 10 to 15% of the male population. Organic factors ar e recognized in 80% of cases. Intracavernosal injections of vasoactive agents (Virag) have provided advances in the physiopathologic underst anding of impotence and provide new ways of treating this incapacity. However this option is unaffective in most organic cases: arteriogenic , venogenic or disorders of smoth cavernous muscle. Vasoactive injecti ons for many reasons are abandoned in about 40% of the cases. Two kind s of surgical management can be performed: microrevascularization in o rder to restore the arterial penile flow or to reduce penile venous fl ow during erection; implantation of penile prosthesis when other thera peutic possibilities are exhausted. Arterialization of the deep dorsal vein (DDV) appears to be the best procedure in arteriogenic and princ ipally venous impotence. Erectile function in these case is restored i n 60% of our patients. Two types of prostheses can be implanted: semi- rigid with an axial permanent rigidity and inflatable or hydraulic dev ices with a flaccid aspect after intercourse. These prostheses are tec hnically successful in 75 to 90% of cases, but partner satisfaction do es not match surgical success rates.