Skip to main content
SpringerLink
Log in

Arterial Surgery for Erectile Dysfunction: Microvascular Arterial Bypass

  • Chapter
Male Infertility and Sexual Dysfunction

  • 396 Accesses

Abstract

Erectile dysfunction is the consistent change in the rigidity or sustaining capability of the penile erection that interferes with satisfactory sexual intercourse. Epidemiology studies have revealed that 52% of men age 40 to 70 years have self-reported minimal (17%), moderate (25%), and complete (10%) forms of impotence.’ Nonsurgical treatment options include psychological, endocrinologic, neurologic, and pharmacologic interventions. Surgical options consist primarily of penile prosthesis insertion and penile microvascular arterial bypass. Surgery for corporal veno-occlusive dysfunction remains controversial, is used in very limited cases, and is associated with poor long-term success.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Goldstein I, Hatzichristou DG. Epidemiology of impotence. In: Bennett A, ed. Impotence: Diagnosis and Management of Erectile Dysfunction. Philadelphia: W.B. Saunders; 1994: 1–17.

    Google Scholar 

  2. Zorgniotti AW, Lizza EF. Complications of penile revascularization. In: Zorgniotti AW, Lizza EF, eds. Diagnosis and Management of Impotence. Philadelphia: B.C. Decker; 1991.

    Google Scholar 

  3. Junemann KP, Persson-Junemann C, Alken P. Pathophysiology of erectile dysfunction. Semin Urol 1990; 8:80–93.

    CAS  Google Scholar 

  4. Frohrib DA, Goldstein I, Payton TR, et al. Characterization of penile erectile states using external computer-based monitoring. J Biomech Eng 1987; 109:110–113.

    Article  PubMed  CAS  Google Scholar 

  5. Michal V, Kramar R, Popischal J, et al. Direct arterial anastomosis on corporal cavernosa penis in therapy of erectile dysfunction. Rozhl Chir 1973; 52:587–590.

    PubMed  CAS  Google Scholar 

  6. Virag R, Zwang G, Dermange H, et al. Vasculogenic impotence: a review of 92 cases with 54 surgical operations. Vasc Surg 1981; 121:774–777.

    Google Scholar 

  7. Virag R, Bouilly P, Frydaman D. Is impotence an arterial disorder? A study of arterial risk factors in 400 impotent men. Lancet 1985; 1:181184.

    Google Scholar 

  8. Levine FJ, Greenfield AJ, Goldstein I. Arteriographically-determined occlusive disease within the hypogastric-cavernous bed in impotent patients following blunt perineal and pelvic trauma. J Urol 1990; 144:1147–1151.

    PubMed  CAS  Google Scholar 

  9. Corso JD, Shamma AR, Meng RL. In-situ saphenous vein bypass. In: Bergan JJ, ed. Arterial Surgery; New Diagnostic and Operative Techniques. Orlando, FL: Grune & Stratton; 1988: 507–522.

    Google Scholar 

  10. Shaw WW. Microvascular surgery. In: Haimovichi H, ed. Vascular Surgery: Principles and Techniques. Norwalk: Appleton-CenturyCrofts; 1988: 289–308.

    Google Scholar 

  11. Hatzichristou DG, Goldstein I. Arterial bypass surgery for impotence. Curr Opin Urol 1991; 1:144–148.

    Article  Google Scholar 

  12. Michal V, Kramer R, Popischal J. Femoropudendal bypass, internal iliac thrombendarterectomy and direct arterial anastomosis to the cavernous body in the treatment of erectile impotence. Bull Soc Int Chir 1974; 33:341–345.

    Google Scholar 

  13. McDougal WS, Jeffrey RF. Microscopic penile revascularization. J Urol 1983; 129:517521.

    Google Scholar 

  14. MacGregor RJ, Konnack JW. Treatment of vasculogenic erectile dysfunction by direct anastomosis of the inferior epigastric artery to the central artery of the corpus cavernosum. J Urol 1982; 131:542–545.

    Google Scholar 

  15. Sharlip I. Retrograde revascularization of the dorsal penile artery for arteriogenic erectile dysfunction. J Urol 1984; 1312:232A.

    Google Scholar 

  16. Crespo F, Soltanik E, Bove D. Treatment of vasculogenic sexual impotence by revascularizing cavernous and/or dorsal arteries using microvascular techniques. Urology 1982; 20:271–275.

    Article  PubMed  CAS  Google Scholar 

  17. Furlow WL, Fisher J, Knoll LD. Penile revascularization: experience with deep dorsal vein arterialization: the Furlow-Fisher modification with 27 patients. Presented at the Sixth Biennial Meeting on Corpus Cavernosum Revascularization and Third Biennal World Meeting on Impotence, Boston: International Society of Impotence Research, 1988.

    Google Scholar 

  18. Balko A, Malhotra CM, Wincze JP. Deep penile vein arterialization for arterial and venous impotence. Arch Surg 1986; 121:774–777.

    Article  PubMed  CAS  Google Scholar 

  19. Bennett AH, Rivard DJ, Blanc RP, et al. Reconstructive surgery for vasculogenic impotence. J Urol 1986; 136:599–602.

    Google Scholar 

  20. Hauri D. A new operative technique in vasculogenic erectile dysfunction. World J Urol 1986; 4:237–249.

    Article  Google Scholar 

  21. Bergamini TM, Towne JB, Bandyc DF, et al. Experience with in-situ saphenous vein bypasses during 1981–1989: determinants of long-term patency. J Vasc Surg 1991; 13:137–149.

    Article  PubMed  CAS  Google Scholar 

  22. Guity A, Young PH, Fisher VW. In search of the “perfect” anastomosis. Microsurgery 1990; 11:5–11.

    Article  PubMed  CAS  Google Scholar 

  23. Siemionow M. Evaluation of different microsurgical techniques for arterial anastomosis of vessels of diameter less than one millimeter. J Reconstr Surg 1987; 3:333–340.

    CAS  Google Scholar 

  24. Wespes E, Corbusier A, Delcour C, et al. Deep dorsal vein arterialization in vascular impotence. Br J Urol 1989; 64:535–540.

    Article  PubMed  CAS  Google Scholar 

  25. Wespes E, deGoes PM, Saltar AA, et al. Objective criteria in the long-term evaluation of penile venous surgery. J Urol 1994; 152:888–890.

    PubMed  CAS  Google Scholar 

  26. Sharlip I. Penile arteriography in impotence after pelvic trauma. J Urol 1981; 126:477–479.

    PubMed  CAS  Google Scholar 

  27. Rosen MP, Greenfield AJ, Walker TG, et al. Arteriogenic impotence: findings in 195 impotent men examined with selective internal pudendal angiography. Radiology 1990; 174: 1043–1048.

    PubMed  CAS  Google Scholar 

  28. Lurie AL, Bookstein JJ, Kessler WO. An giography of post-traumatic impotence. Cardio vasc Intervent Radiol 1988; 11:232–236.

    Article  PubMed  CAS  Google Scholar 

  29. Shiokawa Y, Fazlur Rahman M, Ishii Y, et al. The rate of reendothelialization correlates in versely with the degree of the following intimal thickening in vein grafts: electron microscopic and immunohistochemical studies. Arch [A] 1989; 415:225–235.

    Article  CAS  Google Scholar 

  30. Saenz de Tejada I, Goldstein I, Azadzoi K, et al. Impaired neurogenic and endotheliummediated relaxation of penile smooth muscle from diabetic men with impotence. N Engl Med J 1989; 320:1025–1030.

    Article  Google Scholar 

  31. Pabst TSI, Flanigan DP, Buchbinde D. Reduced intimal injury to canine arteries with controlled application of vessel loops. J Surg Res 1989; 47:235–241.

    Article  Google Scholar 

  32. Machiarelli G, Familiari G, Caggiati M, et al. Arterial repair after microvascular anastomosis: scanning and transmission electron microscopy study. Acta Anat 1991; 140:8–16.

    Article  Google Scholar 

  33. Lue TF. Functional evaluation of penile arteries with papaverine. In: Tanagho EA, Lue TF, McClure RD, eds. Contemporary Management of Impotence and Infertility. Baltimore: Williams & Wilkins; 1988: 57–64.

    Google Scholar 

  34. Kalan JM, Roberts WC. Morphologic findings in saphenous veins used as coronary artery bypass conduits for longer than 1 year: necropsy analy sis of 53 patients, 123 saphenous veins and 1865 five-millimeter segments of veins. Am J Heart 1990; 119:1164–1184.

    Article  CAS  Google Scholar 

  35. Hirsch GM, Karnovsky MJ Inhibition of vein graft intimal proliferative lesions in the rat by heparin. Am J Pathol 1991; 139:581–587.

    PubMed  CAS  Google Scholar 

  36. Hayashi K, Takamizawa K, Nakamura T, et al. Effects of elastase on the stiffness and elastic properties of arterial walls in cholesterol-fed rabbits. Atherosclerosis 1987; 66:259–267.

    Article  PubMed  CAS  Google Scholar 

  37. Corson JD, Leather RP, Balko A, et al. Relationship between vasovasorum and blood flow to vein bypass endothelial morphology. Arch Surg 1985; 120:386–388.

    Google Scholar 

  38. Bush HL, Jakubowski JA, Curl R, et al. The natural history of endothelial structure and function in arterialized vein grafts. J Vasc Surg 1986; 3:204–215.

    PubMed  Google Scholar 

  39. Barada JH, Bennett AH. Penile revascularization: where do we stand? Int J Impotence Res 1990; 2:79–84.

    Google Scholar 

  40. Lewis RW. Arteriovenous surgeries: do they make any sense? In: Lue TF, ed. World Book of Impotence. London: Smith-Gordon; 1992: 199.

    Google Scholar 

  41. Sohn M, Sikora R, Bohndorf K, et al. Selective microsurgery in arteriogenic erectile failure. World J Urol 1990; 8:104–107.

    Article  Google Scholar 

  42. Rosen MP, Greenfield AJ, Walker TG, et al. Cigarette smoking as an independent risk factor Virchows for atherosclerosis in the hypogastric-cavernous bed of men with arteriogenic impotence. J Urol 1991; 145:759–763.

    PubMed  CAS  Google Scholar 

  43. Lehman TP, Jacobs JA. Etiology of diabetic im potence. J Urol 1983; 129:291–294.

    PubMed  CAS  Google Scholar 

  44. Ruzbarsky V, Michal V. Morphologic changes in the arterial bed of the penis with aging: relationship to the pathogenesis of impotence. Invest Urol 1977; 15:194–199.

    CAS  Google Scholar 

  45. Saenz de Tejada I, Moroukian P, Tessier J, et al. The trabecular smooth muscle modulates the capacitor function of the penis: studies on a rabbit model. Am J Physiol 1991; 260:H1590–1595.

    Google Scholar 

  46. Pescatori ES, Hatzichristou DG, Namburi S, et al. A positive intracavernosal injection test im plies normal venoocclusive function but not necessarily normal arterial function: a hemody namic study. J Urol 1994; 151:1209–1216.

    PubMed  CAS  Google Scholar 

  47. Krane RJ, Goldstein I, Saenz de Tejada I. Impo tence. N Engl J Med 1989; 321:1648–1659.

    Article  PubMed  CAS  Google Scholar 

  48. Levine FJ, Goldstein I, Vascular reconstructive surgery in the management of erectile dysfunction. Int J Impotence Res 1990; 2:59–78.

    Google Scholar 

Download references

Authors
  1. John Mulhall
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irwin Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Section of Andrology and Male Infertility Department of Urology, Tulane University School of Medicine, 1430 Tulane Avenue SL 42, 70112-2699, New Orleans, LA, USA

    Wayne J. G. Hellstrom (Associate Professor Urology, Chief) (Associate Professor Urology, Chief)

Rights and permissions

Reprints and permissions

Copyright information

© 1997 Springer Science+Business Media New York

About this chapter

Cite this chapter

Mulhall, J., Goldstein, I. (1997). Arterial Surgery for Erectile Dysfunction: Microvascular Arterial Bypass. In: Hellstrom, W.J.G. (eds) Male Infertility and Sexual Dysfunction. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1848-7_39

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-1848-7_39

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7310-3

  • Online ISBN: 978-1-4612-1848-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation