Antegrade retroperitoneoscopic revascularization of the penis. Successful surgical treatment case of arteriogenic erectile dysfunction

This work presents a clinical case of a successful surgical treatment of arteriogenic erectile dysfunction by antegrade retroperitoneoscopic penile revascularization. This method has been developed, tested, patented and clinically implemented in the center of urology and andrology of State Scientific Center - A.I. Burnazyan Federal Medical Biophysical Center of the Federal Medical and Biological Agency of Russia. The method was developed on the basis of a thorough analysis of the complications and disadvantages of previous revascularization methods.

A Method of Mobilization of the Lower Epigastric Artery for Bypass Penile Revascularization Surgery

The effectiveness of microsurgical revascularization performed according to indications ranges from 85.3% within the first three years of observation and up to 65.5 % during a five-year follow-up. These data are significant evidence of the necessity to rationalize both the indications for this kind of surgery and the surgical techniques. Five revascularization operations were performed using the Virag II and Michal II technique in the Sharlip modification with a satisfactory result. Two-stage combined revascularization, including angioplasty and stent placement in the common iliac artery as the first stage and open penile revascularization surgery as the second stage was performed in one patient. In all the cases, the lower epigastric artery (epigastrica inferior) was used as a donor artery for bypass epigastric-penile anastomosis. The article discusses issues of the mobilization of the above artery for its use as a donor shunt, as well as methods of prevention and diagnosis of arterial thrombosis in it in the postoperative period with the use of duplex ultrasound and angiography.