This review considers diagnosis and treatment of vasculogenic impotence. It describes current information related to normal mechanisms of penile erection and pathophysiology of organic impotence, methods of preoperative diagnosis, quantitative evaluation of penile blood flow and operative techniques to be employed in aneurysmal or occlusive aorto-iliac disease. The importance of preserving internal iliac flow and neural fibres enervating the genitalia is stressed. Large vessel reconstructions have proved practical in maintaining or restoring normal erectile function, but at present reconstructions of isolated pudendal or penile artery occlusions are experimental. Medical therapy can be effective in certain marginal cases of small vessel occlusion.
Progress in treatment of impotence in the past two decades has resulted in impressive advances. While most men respond to medical therapy including prostaglandin E1 injection or the more recent use of urethral alprostadil, 6±7% of men fail to respond to these treatments or vacuum devices. This review considers current and past results of vascular surgery in this group of men. Guidelines for case selection for vascular interventions as well as reporting criteria are suggested. Vascular surgery as a logical ®rst step in selected patients may offer an advantage in men failing conservative therapy and for those not desiring prosthetic implantation.
ConclusionWe ®nd that duplex Doppler evaluation of post prostatectomy patients reveals a low prevalence of cavernous arterial asymmetry in individuals with vasculogenic impotence. This ®nding, in conjunction with the high prevalence of cavernous asymmetry seen in individuals with normal vascular responses, does not support the theory that accessory pudendal sacri®ce leads to post-RRP vascular impotence. References
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