INTRODUCTION AND OBJECTIVES: At the time of traumatic prostatomembranous urethral disruption, the internal pudendal arteries suffer varying degrees of injury. These may put the patient at risk for ischemic stenosis following urethroplasty. Cavernous arterial inflow may also be severely decreased in some of these patients, thus limiting the capacity for both physiologic and pharmacologically induced erections. This report reviews our experience with penile revascularization in a group of carefully selected trauma patients.

METHODS: Between 1994 and 2001, we performed penile revascularization on 8 patients who had suffered prostatomembranous urethral disruptions. These patients were found by both Doppler ultrasound and highly selective angiography to have bilateral injury to the internal pudendal arteries yielding abnormal vascular parameters. The patients underwent revascularization procedures utilizing end-to-side arterial anastomosis between one of their deep inferior epigastric arteries and one or both dorsal penile arteries at the base of the phallus. In one patient with poor donor artery, a “Y” arterial graft of the thoracodorsal artery was interposed between the common femoral artery and the dorsal penile arteries. These patients were then systematically re-evaluated for return of erectile function, for success of subsequent urethral reconstruction, and by Duplex imaging which assessed improvement in vascular parameters.

RESULTS: In all cases there has been a significant increase in arterial inflow to normal by Doppler flow analysis. In these patients, a patent revascularization was demonstrated by Duplex imaging. Patients who underwent subsequent urethral reconstructions suffered no incidence of ischemic stenosis. All patients with vasculogenic erectile dysfunction unresponsive to Sildenafil or intracavernous injection therapy became responders to these agents following this procedure.

CONCLUSIONS: Penile revascularization should be strongly considered in carefully selected patients with documented post-traumatic vasculogenic erectile dysfunction, or prior to urethroplasty in cases of urethral circulatory compromise.