Manning M, Jünemann K P, Scheepe J R, Braun P, Krautschick A, Alken P
Department of Urology, Klinikum Mannheim of the University of Heidelberg, Mannheim, Germany.
J Urol. 1998 Nov;160(5):1680-4.
We report the long-term results of penile revascularization surgery for erectile failure and suggest possible selection criteria for this controversial surgical procedure.
In 7 years 62 impotent men who did not respond to pharmacotherapy underwent microsurgical penile revascularization and completed long-term followup evaluation in 41 months (range 18 to greater than 62) consisting of a detailed questionnaire, duplex sonography and optional pharmacotherapy or angiography. The Virag procedure was chosen for the first 7 patients, the original Hauri technique for the next 13 and the modified Mannheim triple anastomosis for 42.
Of all patients 34% achieved spontaneous and another 20% pharmacologically induced erections. Success in diabetics and older patients was lower (43% for diabetics, 39% for those older than 50 years at surgery), while it was high in men with less than 2 risk factors (58%) as well as in younger patients (69% for those up to 50 years old). Shunt patency was 92%. Complications such as glans hyperemia developed in 13% of patients, shunt thrombosis in 8% and inguinal hernias in 6.5%.
Patient selection is vital for the successful outcome of penile revascularization surgery. We adhere to strict selection criteria, such as patient age maximum of 50 years, less than 2 risk factors, no recent diabetes and termination of nicotine abuse. Penile revascularization surgery is highly indicated in this group of patients, especially since it is the only causal therapy for erectile failure.
我们报告阴茎血运重建手术治疗勃起功能障碍的长期结果，并为此存在争议的手术提出可能的选择标准。
7年间，62例对药物治疗无反应的阳痿患者接受了显微外科阴茎血运重建手术，并在41个月（范围18至大于62个月）内完成了长期随访评估，包括详细问卷、双功超声检查以及可选的药物治疗或血管造影。最初7例患者采用维拉格手术，接下来13例采用原始的豪里技术，42例采用改良的曼海姆三重吻合术。
所有患者中，34%实现了自然勃起，另外20%通过药物诱导勃起。糖尿病患者和老年患者的成功率较低（糖尿病患者为43%，手术时年龄大于50岁的患者为39%），而风险因素少于2个的男性（58%）以及年轻患者（50岁及以下患者为69%）的成功率较高。分流血管通畅率为92%。13%的患者出现了如龟头充血等并发症，8%出现分流血栓形成，6.5%出现腹股沟疝。
患者选择对于阴茎血运重建手术的成功结果至关重要。我们坚持严格的选择标准，如患者年龄最大50岁、风险因素少于2个、近期无糖尿病且已戒烟。对于这类患者，阴茎血运重建手术具有高度指征，特别是因为它是勃起功能障碍的唯一病因治疗方法。
