Microvascular arterial bypass surgery: long-term outcomes using validated instruments

Abstract

Purpose: Penile microarterial bypass surgery may be the only treatment capable of restoring normal erectile function without the necessity of chronic use of vasoactive medications or placement of a penile prosthesis. Lack of standardization in patient selection, hemodynamic evaluation, surgical technique and limited long-term outcome data using validated instruments have resulted in this surgery being considered experimental. In this study we report long-term outcome data using validated questionnaires in young men (younger than 55 years) free of vascular risk factors who underwent microvascular arterial bypass surgery.

Materials and methods: This is a single institution retrospective institutional review board approved study of 71 men (mean age 30.5 +/- 9.2 years) who underwent microvascular arterial bypass surgery between 1996 and 2007 (mean followup 34.5 +/- 18 months).

Results: Mean preoperative and postoperative penile rigidity measures with and without phosphodiesterase type 5 inhibitors were 41%, 77% and 71%, 90.8%, respectively. Mean total International Index of Erectile Function score, Erectile Function domain, and question 3 and 4 scores preoperatively and postoperatively were 35.5 +/- 14.8, 13.7 +/- 6.7, 2.2 +/- 1.4 and 2.1 +/- 1.3, and 56.2 +/- 16.6, 23.8 +/- 6.6, 4.1 +/- 1.4 and 3.9 +/- 1.5, respectively. Preoperative and postoperative Center for Epidemiologic Studies Depression Scale scores were 42.0 +/- 10.0 and 33.7 +/- 6.1. Treatment satisfaction according to the Erectile Dysfunction Inventory of Treatment Satisfaction was high. All differences were statistically significant. Short-term complications included emesis (2 of 71), dysuria (5 of 71) and wound infection (2 of 71). Long-term complications were loss of penile length (20 of 71) and decreased penile sensation (18 of 71). There were no cases of prolonged penile pain or glans hyperemia.

Conclusions: In patients with no vascular risk factors and pure cavernous arterial insufficiency, microvascular arterial bypass surgery provides long-term improvements in erectile function, depression and overall satisfaction.