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Abstract

Volume 15, Issue 1 (January 2013) 15, 5–9; 10.1038/aja.2012.146

Penile revascularization--contemporary update

Brian Dicks1, Martin Bastuba2 and Irwin Goldstein1

1 San Diego Sexual Medicine, San Diego, CA 92120, USA
2 Male Fertility Sexual Medicine Specialists, San Diego, CA 92120, USA

Correspondence: Professor I Goldstein, (dr.irwingoldstein@gmail.com)

Received 8 October 2012; Revised 15 November 2012; Accepted 18 November 2012

Abstract

Contemporary therapies for erectile dysfunction are generally targeted towards older men and universally engage pharmacological and/or device related treatment options. Penile revascularization, using microvascular arterial bypass surgical techniques, is a non-pharmacological, non-device-related, and reconstructive surgical strategy for men with erectile dysfunction that was first described by Dr Vaclav Michal in 1973. Contemporary penile revascularization attempts to 'cure' pure arteriogenic erectile dysfunction in young men with arterial occlusive pathology in the distal internal pudendal, common penile or proximal cavernosal artery secondary to focal endothelial injury from blunt pelvic, perineal or penile trauma. A microvascular anastomosis is fashioned between the donor inferior epigastric and recipient dorsal penile artery. Increased perfusion pressure is theoretically communicated to the cavernosal artery via perforating branches from the dorsal artery. This article will review the history, indications and pathophysiology of blunt trauma-induced focal arterial occlusive disease in young men with erectile dysfunction, current surgical techniques utilized and results of surgery. Contemporary use of penile revascularization is a logical and wanted therapeutic option to attempt to reverse erectile dysfunction in young men who have sustained blunt pelvic, perineal or penile trauma.


Keywords:erectile dysfunction; microvascular arterial bypass surgery; penile revascularization; traumatic arterial occlusive disease; vascular reconstructive surgery

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