The diagnosis and surgical management of vasculogenic impotence.

Thirty-two patients have been treated for organic impotence at our institution during a 16-month period. Of these patients 5 were found to have penile vascular insufficiency and underwent a femorocavernosal bypass with an autogenous saphenous vein graft. Initial results were excellent but late failures occurred. At 28 months all shunts were occluded. Microscopic examination of the cavernous tissue revealed fibrous thickening of the septa and loss of cavernous spaces. These findings suggested that late failure in direct revascularization may be associated with fibrotic changes that occur under high pressure inflow to the corpora cavernosa.