Objectives: The treatment of vascular erectile insufficiency may require surgery because of the high failure rate of intracavernous injections. Implantation of penile prostheses is a last resort which can be avoided in certain selected patients in whom vascular surgery can be proposed. However, the modalities and results of this type of treatment remain controversial. We therefore evaluated the results of two different techniques.
Material and methods: From 1st January, 1985 to 31st December, 1995, 114 patients were operated for impotence due to pure veno-cavernous incompetence in 23 cases (20%), associated with arterial disease in 38 cases (46%) or purely arterial insufficiency in 39 cases (34%). The mean age was 47.5 +/- 11 years (range: 20 to 74). These patients had suffered from erectile insufficiency for an average of 33.3 +/- 3 years. Pharmacological erection tests achieved rigid erection in only 6 cases. Two surgical techniques were used: end-to-end bypass graft between the epigastric artery and the dorsal artery of the penis (DAP) in 44 cases and arterialisation of the deep dorsal vein of the penis (DVP) in 71 cases.
Results: Overall, there were 54 good results (48%), defined by return of normal erections allowing satisfactory sexual intercourse without any complementary 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 associated arterial disease (52%) of good results), but poorer results (31% of good results) were obtained in the case of pure arterial disease. The results were not statistically influenced by age or the presence of graft in all 3 types of erectile insufficiency, arterial, veno-cavernous or mixed. However, this difference was only statistically significant for pure veno-cavernous incompetence. The morbidity of arterialisation of the DVP was marked by high-flow syndrome in 21% of cases (n = 15), requiring surgical revision in 77% of cases (n = 11). Interestingly, 85% of good results on erectile function were obtained in this subgroup.
Conclusion: The results obtained in this series of vascular erectile impotence, regardless of the aetiology of erectile insufficiency, are in favour of the better efficacy of arterialisation of the DVP compared to arterial bypass graft. The biological mechanisms underlying this better result need to be elucidated.