Improved results with intracavernous vasoactive drug infusion following new surgical techniques for vasculogenic impotence

Summary A large percentage of patients suffering from organic impotence will exhibit arterial insufficiency and/or compromise of the venous closure mechanism. In our institution, patients with organic impotence undergo penile Doppler studies, dynamic cavernosometry and cavenosography and when indicated, penile angiography. At present, patients with arterial insufficiency undergo either a single end-to-end anastomosis between the inferior epigastric artery and the distal segment of the dorsal artery of the penis or double end-to-end anastomosis utilizing both epigastric arteries to both the proximal and distal ends of the dorsal artery. In addition, patients receive post-operative cavenosal infusion of vasoactive agents. We have been able to increase our potency rate from 42% to 82% utilizing newer surgical techniques in combination with post-operative cavernosal infusion. In addition, we report on 234 patients in whom selective ligation of incompetent veins has been performed with a nine-month 55% potency rate. In selected patients with milder vasculogenic syndromes, cyclic cavernosal infusion of papaverine and phentolamine has produced a 40% potency rate.