Revascularization of cavernous bodies in erectile dysfunction

Revascularization of the cavernous bodies (CB) has its place in a highly se lected patient population as the only causal therapy for erectile dysfuncti on (ED) and provides an alternative to the implantation of alloplastic erec tile aids. The indication for arterialization of the CB is currently only established when conservative treatment has failed. The most important criteria for the intervention are controversial: an age of under 50, an incidence of not mo re than two classical risk factors for impotence and the exclusion of diabe tes mellitus. The leading revascularization procedure in German-speaking countries compri ses arteriovenous shunting of the inferior epigastric artery with the dorsa l vein and artery of the penis. A retrospective analysis of results is problematic due to the nonuniform in dicational criteria, the multiplicity of applied revascularization procedur es and a nonstandardized follow-up. Subjective assessment of improved erect ility is the sole target criterion in the majority of studies. Therapeutic results range from 33 to 87 % with regard to subjective success rates. Atte mpts to objectify the treatment results were made in only few of the studie s and disclosed bypass patency in 44 to 92 % one year after the interventio n. The conclusions drawn at the last "Consensus Development Conference on Impo tence'' (CDCI) of the National Institutes of Health (NTH) in Washington hav e not lost their topicality in view of the great number of still unanswered questions. Then the recommendation was made in 1992 to perform penile arte rialization only in controlled prospective clinical trials. The European Ur ological Association (EUA) is currently organizing a Consensus Conference t hat will provide the framework for prospective studies that can serve as a basis for clarifying the open questions.