Penile revascularization for erectile dysfunction (ED), also known as microvascular arterial bypass surgery for impotence, is similar to a cardiac bypass. The goal of this surgery is to restore proper blood flow to the penis by bypassing the blocked artery. The procedure is highly specialized and requires a specialist with an extensive amount training in microvascular surgery. The most ideal candidates for this procedure are young men with a history of perineal or pelvic trauma in whom arteriography reveals a localized common penile artery lesion. This procedure is not recommended for men with atherosclerosis, a condition that causes hardening of the arteries, which can lead to permanent damage to the lining of the blood vessels of the penis.
Performed with anesthesia in the hospital and taking approximately 4-6 hours, this procedure allows the doctor to surgically bypass blocked penile arteries by connecting an artery in the lower abdomen to one at the top of the penis. This new connection bypasses the blockage and delivers increased pressure and blood flow from the new donor artery to the patient’s existing penile artery, allowing for an erection to occur. Patients will routinely stay in hospital for a single night, miss at least one week from work and need to avoid all types of physical exertion including sexual activity for several weeks after surgery.
How Successful Is Penile Revascularization?
Success is based on how appropriate a candidate the patient is for the surgery and the experience and training of the surgeon. This is not an operation that should be routinely performed by a urologist or surgeon who has not received special training in this form of microsurgery. Most published studies have suggested that approximately 50% of men will be cured at 2-5 years following surgery. Besides this group there are men who have shown improvement post surgery but still require the use of medications to help attain an erection.
Complications and side effects of penile revascularization may include uncontrolled arterial bleeding as a result of blunt trauma (e.g., accidents, sexual intercourse) during the first few postoperative weeks. Other complications can also include penile pain, reduced penile sensation, and priapism (an erection lasting 4 hours or more).