Traumatic Vasculogenic Erectile Dysfunction: Role of Penile Microarterial Bypass Surgery
Tóm tắt
Penile microarterial bypass surgery (MABS) may be the only treatment capable of restoring normal erectile function without necessity of chronic use of vasoactive medications or placement of a penile prosthesis. Lack of standardization in patient selection, hemodynamic evaluation, surgical technique, and limited long-term outcome data using validated instruments has resulted in this surgery being considered experimental. In addition, poor reimbursements, long surgical time, and the need for microsurgical expertise have lead to infrequent penile revascularization procedures. Using the criteria for the Arterial Occlusive Disease Index patient, only 4 of 31 manuscripts met the criteria. The total studied population of these four publications was 50, which was considered too small to determine if MABS is effective or not. Reported successful outcomes were 36% to 91%. We recently published the largest long-term outcome MABS study using validated instruments. We documented MABS provides long-term improvements in erectile function, depression, and overall satisfaction in well-selected patients. The Members of the Erectile Dysfunction Guideline Update Panel consider: “Arterial reconstructive surgery is a treatment option only in healthy individuals with recently acquired erectile dysfunction secondary to a focal arterial occlusion and in the absence of any evidence of generalized vascular disease.”
Tài liệu tham khảo
Feldman HA, Goldstein I, Hatzichristou DG, et al.: Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994, 151:54–67.
Michal V, Kramar R, Pospichal J, Hejhal L: Direct arterial anastomosis to the cavernous body in the treatment of erectile impotence. Czech Rozhledy Chir 1973, 52:587–593.
Michal V, Kramer R, Hejhal L: Revascularization procedures of the cavernous bodies. In Vasculogenic Impotence: Proceedings of the First International Conference on Corpus Cavernosum Revascularization. Edited by Zorgniotti AW, Ross G. Springfield, IL: Charles C Thomas; 1980:239–255.
Virag R, Zwang G, Dermange H, Legman M: Vasculogenic impotence: a review of 92 cases with 54 surgical operations. Vasc Endovascular Surg 1981, 15:9–17.
Furlow WL, Fisher J: Deep dorsal vein arterialization: clinical experience with a new technique for penile revascularization [abstract 543]. J Urol 1988, 139:298A.
Hauri D: Therapiemoglichkeitem bei der vascular bedingten erectilein impotenz. Akt Urol 1984, 15:350.
Jarow JP, DeFranzo AJ: Long-term results of arterial bypass surgery for impotence secondary to segmental vascular disease. J Urol 1996, 156: 982–985.
•• Montague DK, Jarow JP, Broderick GA, et al.: Erectile Dysfunction. The Management of Erectile Dysfunction: An Update. Baltimore: American Urological Association; 2007. This is the first publication that provides criteria for the Arterial Occlusive Disease Index patient.
•• Munarriz R, Uberoi J, Fantini G, et al.: Microvascular arterial bypass surgery: long-term outcomes using validated instruments. J Urol. 2009, 182:643–648. This article details the largest microarterial bypass surgery outcome series using validated instruments.
Mulhall JP, Abdel-Moneim A, Abobakr R, Goldstein I: Improving the accuracy of vascular testing in impotent men: correcting hemodynamic alterations using a vasoactive medication re-dosing schedule. J Urol 2001, 166:923–926.
Chung WS, Park YY, Kwon SW: The impact of aging on penile hemodynamics in normal responders to pharmacologic injection: a Doppler sonographic study. J Urol 1997, 157:2129–2131.
Grasso M, Lania C, Castelli M, et al.: Deep dorsal vein arterialization in vasculogenic impotence: our experience. Arch Ital Urol Nefrol Androl 1992, 64:309–312.
DePalma RG, Olding M, Yu GW, et al.: Vascular interventions for impotence: lessons learned. J Vasc Surg 1995, 21:576–584.
Ang LP, Lim PH: Penile revascularisation for vascular impotence. Singapore Med J 1997, 38:285–288.