Vascular Surgery Offers Uncertain BenefitsVascular disease is common as men age and is probably the leading cause of erectile dysfunction for men over 50, so many wonder why vascular surgery isn’t more common. Many ask why vascular surgery cannot correct erectile dysfunction and offer the same life changing benefits as arterial bypass heart surgery.
The answer is that attempts to reproduce the successes of heart surgery in correcting erectile dysfunction have shown some good results in the short term (23 – 80 per cent in first year) but failed to deliver long term, probably because the underlying cause of the erectile dysfunction was not addressed.
Vascular Surgery Low Success RatesAfter doing a meta-analysis of literature reports, the American Urological Association’s Clinical Guidelines Panel, in 1996, declared that the chances of success for both arterial and venous surgery for ED were too low to justify routine surgery, especially in older patients with vascular disease.
Current studies show arterial surgery (technical term penile arterial revascularization) has a better chance of success that venous surgery, (penile venous ligation – same principle as stripping varicose veins) for which the success rates are lower and generally short term.
A third possibility, offering penile stents to direct arterial blood flow, is also under investigation with trials being conducted in ten medical centres across the US.
Arterial Surgery for Erectile DysfunctionFor young men with a congenital problem or traumatic injury resulting in erectile dysfunction, like a pelvic fracture, and where the ED is entirely due to blockage of an artery, vascular surgery may offer a cure. However most urologists consider the chances of long term success doubtful.
As with penile implants, vascular surgery is not likely to benefit older men with normal age-related erectile dysfunction, or anyone, young or old, who has vascular risk factors like diabetes, high blood pressure, lipid disorders, cigarette smoking.
Vascular Surgery Check List For SuccessSpecialists involved in sexual medicine emphasise success is likely only for carefully selected young men, and have developed a check list for suitable vascular surgery candidates which includes:
- Have strong sex drive
- Experience a consistent reduction in erectile hardness during sexual activity
- Have normal hormone levels
- Have arterial blockage in the penis
- Have a long enough donor artery to complete the procedure
- Have an experienced micro-vascular surgeon
Controversy remains as to the long term success of arterial revascularization for erectile dysfunction and the procedure does not have wide spread acceptance even amongst urologists.
Venous Leakage SurgerySurgery which attempts to treat penile veins has shown limited long term benefits and is regarded as purely investigational by most reputable doctors.
Venous leakage is believed to be caused by structural changes in the erectile tissue and the idea it can be remedied by ligation of the venous channels has little scientific basis. Although it enjoyed popularity in the 80s, the procedure has fallen out of favour because of the poor long term results.