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Microvascular Arterial Bypass Surgery: Prospective Outcomes Study Using Validated Instruments
Christopher E Graziano, Ricardo Munarriz
Boston Medical Center, Boston, MA

Introduction: 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 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) free of vascular risk factors who underwent microvascular arterial bypass surgery.
Materials & Methods: This is a single institution prospective institutional review board approved study of 38 men (mean age 28.2 + 8.7 years) who underwent microvascular arterial bypass surgery between 2000 and 2010.
Results: Mean preoperative and postoperative penile rigidity measures without and with phosphodiesterase type 5 inhibitors were 43%, 75% and 77%, 94%. Mean total International Index of Erectile Function score, Erectile Function domain, and question 3 and 4 scores preoperatively and postoperatively were 41.5 + 17.0, 16.4 + 8.2, 2.9 + 1.9 and 2.5 + 1.8, and 53.5 +13.3, 23.7 + 5.8, 4.2 + 1.5 and 3.7 + 1.5. Preoperative and postoperative Center for Epidemiologic Studies Depression Scale scores were 18.4 + 15.1 and 14.2 + 13.1. Short-term complications included emesis and dysuria. Long-term complications were loss of penile length and decreased penile sensation.
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.


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