Vascular microsurgery in the treatment of vascular erectile insufficiency:clinical experience based on 115 operations performed according to two different surgical techniques.

Objectives : The treatment of vascular erectile insufficiency may require s urgery because of the high failure rate of intracavernous injunctions. Impl antation of penile prostheses is a Inst resort which can be avoided in cert ain selected patients in wham vascular surgery con be proposed. However; th e modalities and results of this type of treatment remain controversial. We therefore evaluated the results of two different techniques. Material and Methods : From Ist January 1985 to 31st December; 1995, 114 pa tients were operated for impotence due to pure veno-cavernous incompetence in 23 eases (20%), associated with arterial disease in 38 cases (46%) or pu rely arterial insufficiency in 39 cases (34%). The mean age was 47.5 rt II years (range : 20 to 74). These patients had suffered from erectile insuffi ciency for an average of 33.3 +/- 3 years. Pharmacological erection tests a chieved rigid erection in only 6 cases. Two surgical techniques were used : end-to-end bypass graft between the epigastric artery and the dorsal arter y of the penis (DAP) in 44 cases and arterialisation of the deep dorsal vei n of the penis (DVP) in 71 cases. Results : Overall, there Mere 54 good results (48%), defined by return of n ormal erections allowing satisfactory! sexual intercourse without any compl ementary treatment, 15 improvements (14%) and 45 failures (38%) with a mean follow-up of 18 months (range :3 to 120). These results were equivalent in the case of pure veno-cavernous incompetence (65% of good results) or asso ciated arterial disease (52% of good results), but poorer results (31% of g ood results) were obtained in the case of pure arterial disease. The result s were not statistically influenced by age or the presence of graft in all 3 types of erectile insufficiency arterial, veno-cavernous or mixed. Howeve r this difference was only statistically significant for pure veno-cavernou s incompetence. The morbidity of arterialisation of the DVP was marked by h igh-flow syndrome in 21% of cases (n = 15) requiring surgical revision in 7 7% of cases (n = 11). Interestingly, 85% of good results on erectile functi on were obtained in this subgroup. Conclusion :The results obtained ia this series of vascular erectile impote nce, regardless of the aetiology of erectile insufficiency,are in favour of the better efficacy of arterialisation of the DVP compared to arterial byp ass graft The biological mechanisms underlying this better result need to b e elucidated.