Penile revascularization in vasculogenic erectile dysfunction (ED): long-term follow-up

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? This study reflects the second largest series of revascularization operations performed in different etiologic and risk groups with the longest follow up. Beyond that this is the only study in which CC‐EMG techniques were used preoperatively to exclude some patients and to predict postoperative success in penile revascularization.

OBJECTIVE

? To determine the overall long‐term success of penile revascularization surgery in the treatment of vasculogenic erectile dysfunction (ED) and also to investigate the effect of risk factors on the results of a modified Furlow–Fisher technique.

PATIENTS AND METHODS

? Between 1999 and 2010, 125 men with a mean (sd , range) age of 43.2 (11.3, 23–69) years underwent penile revascularization surgery. In all, 110 men completed the long‐term follow‐up with a mean follow‐up of 73.2 months. ? Diagnostic evaluations, penile colour Doppler ultrasonography, corpus cavernosum electromyography, and cavernosometry, were performed in all the men before surgery. ? The efficacy of the surgery was assessed as improvement or failure according to the change in the five‐item version of the International Index of Erectile Function (IIEF‐5). A ≥5 point increase in the IIEF‐5 score during the latest patient visit after surgery compared with that before surgery was regarded as improvement (surgical success).

RESULTS

? The mean (sd ) IIEF‐5 score was 7.3 (3.2) before surgery and at the end of the follow‐up periodit was 16.8 (3.1). ? The success rates were 81.8% at 3 months, 77.2% at 1 year, 70% at 2 years, 66.3% at 3 years and 63.6% at 5 years after surgery in the men who achieved a no‐ED threshold score of >26 in the IIEF‐15. ? The success rate was the highest in the men with no risk factors (92.8%). ? Seven patients (6.36%) showed signs of glans hypervascularization as a major complication.

CONCLUSIONS

? Penile revascularization surgery has not been widely used by urologists probably due to the technical difficulties and the use of phosphodiesterase type 5 inhibitors. ? However, with reported high rates of noncompliance or failure of oral pharmacotherapy it seems likely that this surgery will become more popular in the near future.