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Out of 400 patients with erectile lesions, Doppler flowmetry in combination with nitroglycerin stimulation showed a decreased penile arterial blood flow in 42 males. Dynamic cavernosography and cavernosometry showed a concomitant increase of venous drainage in 38 of them. Phalloarteriography in 22 males demonstrated an occlusion of the interna pudendal artery in 21. In 15 patients penile arterialization was done by interposition of a saphenous vein-graft between the iliac artery and the deep dorsal penile vein. In four of these patients an additional venous leak was treated during the same operation by ligation of the internal iliac veins. Two years postoperatively, two of three of the patients are doing well. Failures in five included four diabetic neurovascular lesions and one postoperative priapism.

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The cost-advantage relationships in the use of microsurgical equipment and techniques in various medical fields are examined. Cost-effectiveness in clinical urology appears to support the use of microsurgery. Specific applications to urethroplasty, pyeloplasty, renal stone surgery, and renal trauma, are discussed.