Indications for penile revascularization and long-term results

Zumbé, J.; Drawz, G; Wiedemann, Andreas; Grözinger, K. H.; Engelmann, U.

doi:10.1111/j.1439-0272.1999.tb01455.x

Cited by 8 publications

(3 citation statements)

References 13 publications

(7 reference statements)

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“…The patients were classified as satisfied or dissatisfied. In those who were satisfied, there was a high correlation (63/74, 85%) between graft patency as judged by US and erectile function [27]. The present study is the second largest series of patients published with long-term follow-up.…”

Section: © 2 0 11 T H E a U T H O R S 11 2 B J U I N T E R N A T I O mentioning

confidence: 79%

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

Kayıgίl¹,

Okulu²,

Aldemir³

et al. 2011

BJU International

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Study Type – Therapy (case series)Level of Evidence 4What’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.

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Section: © 2 0 11 T H E a U T H O R S 11 2 B J U I N T E R N A T I O mentioning

confidence: 79%

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

Kayıgίl¹,

Okulu²,

Aldemir³

et al. 2011

BJU International

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“…17 Recognizing the internal pudendal artery is essential for accurate diagnosis of arteriogenic ED and to perform safe and effective revascularization procedures. 14,[18][19][20] The presence of diffuse atherosclerotic lesions of the pelvic vessels frequently found in arteriogenic ED increases the difficulty in correctly identifying and distinguishing the internal iliac collaterals.…”

Section: Discussionmentioning

confidence: 99%

Anatomia Radiológica da Disfunção Erétil Arteriogénica: Uma Abordagem Sistematizada

Pereira¹,

Bilhim

Tinto³

et al. 2013

Acta Med Port

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Introdução: A disfunção erétil é uma doença com elevada prevalência existindo crescente interesse na sua terapêutica endovascular. Devido à complexidade do sistema arterial pélvico masculino, o conhecimento anatómico é fundamental. Avaliou-se a aplicabilidade da classificação de Yamaki na avaliação de doentes com disfunção erétil arteriogénica usando a Angiografia Tomográfica Computorizada e a Angiografia Digital de Subtração.Métodos: Análise retrospetiva dos achados imagiológicos de Angiografia Tomográfica Computorizada e Angiografia Digital de Subtração em 21 doentes do sexo masculino, com suspeita de disfunção erétil arteriogénica, que foram submetidos a embolização pélvica seletiva numa única instituição. A função erétil foi avaliada através do IIEF-5. O padrão de bifurcação da Artéria Ilíaca Interna foi caracterizado de acordo com a classificação de Yamaki. O diagnóstico da disfunção erétil arteriogénica foi feita baseado na presença de lesões ateroscleróticas da Artéria Ilíaca Interna e da Artéria Pudenda Interna.Resultados: A idade média foi de 67,2 anos; a média do IIEF foi 10,6 pontos. A Angiografia Tomográfica Computorizada e a Angiografia Digital de Subtração permitiram a classificação de todos os 42 lados pélvicos de acordo com a classificação de Yamaki. Vinte e quatro lados pélvicos foram classificados como Grupo A (57%), nove como Grupo B (21,5%) e nove como Grupo C (21,5%). A Angiografia Digital de Subtração detectou 19 Artérias Pudendas Internas anormais (lesões ateroscleróticas) (45%). A Angiografia Tomográfica Computorizada detectou 24 Artérias Pudendas Internas anormais (57%).Conclusão: Os achados por Angiografia Tomográfica Computorizada e Angiografia Digital de Subtração incluem estenoses e oclusões da Artéria Ilíaca Interna e da Artéria Pudenda Interna. A classificação de Yamaki tem reprodutibilidade radiológica e permite o reconhecimento da Artéria Pudenda Interna em doentes com disfunção erétil arteriogénica.

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“…In a further study [103], success in diabetics and older patients was lower (43% for diabetics, 39% for those older than 50 years at surgery). Based upon their experience, Zumbe [104] recommended the following important factors in case selection for arterial surgery: (i) non‐responder to ICI; (ii) age less than 55 years; (iii) non‐diabetic; (iv) cavernous leakage excluded; (v) stenosis in the internal pudendal artery.…”

Section: Arterial Revascularizationmentioning

confidence: 99%

Implants, Mechanical Devices, and Vascular Surgery for Erectile Dysfunction

Hellstrom

Montague

Moncada

et al. 2010

The Journal of Sexual Medicine

138

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Introduction The field of erectile dysfunction (ED) is evolving and there is a need for state-of-the-art information in the area of treatment. Aim To develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery. Methods To provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period. Main Outcome Measure Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Results The inflatable penile prosthesis (IPP) is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis. Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma. Currently, surgery to limit venous leakage is not recommended. Conclusions It is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient’s medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery.

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Indications for penile revascularization and long-term results

Cited by 8 publications

References 13 publications

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

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

Anatomia Radiológica da Disfunção Erétil Arteriogénica: Uma Abordagem Sistematizada

Implants, Mechanical Devices, and Vascular Surgery for Erectile Dysfunction

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