Penile revascularization: an overview
Shah, R.S.; Kulkarni, V.R.
Annals of the Academy of Medicine Singapore 24(5): 749-754
1995
ISSN/ISBN: 0304-4602 PMID: 8579325 Document Number: 454330
Penile revascularization offers the possibility of restoring natural erections in selected cases of vasculogenic impotence. Men who have an isolated block in the internal pudendal artery may be cured by anastomosis of the inferior epigastric artery to the dorsal penile artery. In men with congenital arterial dysplasia or cavernosal arterial disease, the corpora can be revascularized by the arterialization of the deep dorsal vein. In the Virag-type procedures, the epigastric artery is anastomosed to the deep dorsal vein at the base of the penis; blood flows retrograde through the veins and enters the corpora through the connecting posterior emissary veins. A new procedure that permits antegrade arterialization of the dorsal vein has been developed (Parulkar-Shah ADVA procedure). In this, the distal (glandular) half of the dorsal vein is completely mobilized, divided near the glans and then flipped back to lie upon the symphysis pubis where it is anastomosed end-to-end to the inferior epigastric artery. This procedure works on the same principle as the Virag procedure but has the advantage that the flow of blood is in the direction of the venous valves; hence the valves do not have to be ruptured. Venogenic impotence can be treated by dorsal vein arterialization in combination with venous ligation.