Penile Vascular Surgery

Isolated stenosis or occlusion of the extrapenile arteries is amenable to surgical repair. Restoration of potency has been reported after surgery of the internal iliac and internal pudendal arteries. Currently, the most commonly used technique for penile revascularization is a bypass from the inferior epigastric artery to the dorsal artery or deep dorsal vein of the penis. This procedure is indicated only in young men with congenital or traumatic arterial insufficiency (_{Hakim et al, 1995}). In men with generalized vascular disease secondary to hyperlipidemia, diabetes mellitus, chronic hypertension, and similar conditions, this procedure does not produce durable results and therefore is not recommended.

Penile venous surgery is also indicated only in young men with congenital or traumatic venous leakage. In congenital venous leakage, the venous insufficiency is typically through abnormal crural veins or superficial dorsal veins and is amenable to surgical cure (_{Lue, 1999}). Traumatic venous leak is usually due to localized damage to the tunica albuginea or formation of a "fistula" between the corpus cavernosum and corpus spongiosum. Repair of the tunica or closure of the fistula can result in significant improvement of erectile function. In older men with chronic systemic diseases, the cause of leakage is atrophy of the cavernous smooth muscle and intracavernous fibrosis; ligation of the penile vein will only produce transient improvement and is not recommended.