Penile revascularization is a surgical procedure designed to improve blood flow to the penis. Its purpose is to treat certain cases of erectile dysfunction (ED) by creating a new path for blood to enter the erectile tissues, bypassing any blockages that prevent a normal erection. This operation is performed on the much smaller arteries of the penis using microsurgical techniques. It is a highly specialized treatment reserved for a select group of men for whom other common treatments are not suitable or have been ineffective. It directly addresses a physical impediment to blood flow, differentiating it from medications or penile implants by aiming to restore the natural erectile mechanism.
The Specific Cause of ED Addressed by Revascularization
Penile revascularization specifically treats arteriogenic erectile dysfunction. This type of ED occurs when arteries delivering blood to the penis become blocked or narrowed, a condition called arterial insufficiency. For an erection, these arteries must allow a rapid surge of blood to fill the corpora cavernosa. When this inflow is restricted, achieving a full erection is difficult or impossible.
This blockage is often caused by atherosclerosis, the same process that leads to heart disease, or by direct physical trauma. The reduction in blood supply prevents the penis from becoming engorged with the blood needed for rigidity.
This cause of ED is distinct from other forms like veno-occlusive dysfunction (a “venous leak”), where veins fail to trap blood inside the penis. Other causes can be neurological or hormonal. Since revascularization only corrects arterial inflow, it is not effective for these other issues.
The procedure is most effective when the blockage is localized to a main artery. Widespread vascular disease makes a surgical bypass less likely to succeed long-term. Therefore, identifying the precise location of the problem is a fundamental step before considering surgery.
Candidate Selection for the Procedure
Determining who is a suitable candidate involves a thorough diagnostic process. The ideal individual is a younger man, often under 55, who developed erectile dysfunction from a traumatic injury that damaged a specific, localized segment of a penile artery.
These candidates should have an isolated arterial blockage rather than a systemic disease. An older man with widespread atherosclerosis, diabetes, or uncontrolled high blood pressure is a poor candidate. The underlying disease would likely affect the new bypass artery over time, leading to a recurrence of the problem.
To confirm the diagnosis, specialists perform a penile Doppler ultrasound. This non-invasive test measures blood flow in the penile arteries after an injection induces an erection. If the ultrasound reveals poor arterial inflow, an arteriogram may be used. This procedure provides a detailed map of the arteries, allowing surgeons to pinpoint the blockage and determine if a bypass is feasible.
The Surgical Process Explained
Penile revascularization is a delicate microsurgical procedure performed under general anesthesia that takes several hours. The goal is to create a detour around the blocked arterial segment using a healthy artery from another part of the patient’s body. The most common donor vessel is the inferior epigastric artery, located in the lower abdominal wall.
The surgeon makes an incision in the lower abdomen to free a length of the inferior epigastric artery, which is then rerouted to the base of the penis. The next step requires microscopic precision, as the surgeon connects the donor artery to a penile artery just beyond the blockage. The target is often the dorsal artery of the penis.
This new connection bypasses the damaged section, restoring direct blood flow into the penile erectile tissues. Once the connection is confirmed to be secure with blood flowing freely, the incisions are closed. The procedure’s complexity requires a surgeon with extensive training in microsurgery.
Following the operation, patients have a hospital stay of one to two days for monitoring. The recovery period involves several weeks of restricted activity. Strenuous physical exertion, heavy lifting, and all sexual activity are prohibited for four to six weeks to allow the new connection to heal. Patients receive pain medication and specific instructions for wound care.
Outcomes and Potential Complications
In ideal candidates, specifically young men with a single traumatic arterial blockage, initial outcomes can be positive. Studies report that a significant percentage of these men regain the ability to have erections sufficient for intercourse without other aids. Some research suggests that approximately half of the men who undergo the procedure maintain this benefit two to five years after surgery.
The long-term durability of the results can vary. The bypass itself can fail over time as the connection site can develop narrowing or become completely blocked. This is more likely in individuals who have underlying vascular diseases that progress after surgery. For some patients, the improvement is partial, and they may still need oral medications.
Like any major surgery, penile revascularization carries potential risks. Complications can include infection at the incision sites or uncontrolled bleeding. The primary risk is the failure of the graft, which would result in a return of the erectile dysfunction. Changes to penile sensation can also occur, though this is not a common outcome.