Background: Young men (<55 yrs) free of vascular risk factors with pure cavernosal arterial insufficiency secondary to blunt perineal trauma are classically considered excellent candidates for microvascular arterial bypass surgery (MABS). Though bypass surgery offers hope of permanent cure of erectile dysfunction, there is limited long-term data regarding its effects. The aim of this study was to compare pre-operative and post-operative sexual function via validated questionnaires in a large cohort of men who underwent MABS.
Methods: This is an IRB approved retrospective study of 77 patients (mean age 32.7 ± 10.0 years) who underwent microscopic revascularization from the Inferior Epigastric to Dorsal Penile Artery between 1998 and 2006 (mean follow up 41.6 ± 19.2 months). Subjects completed the International Index of Erectile Function (IIEF), the Sexual Distress Scale (SDS), the Center for Epidemiologic Studies Depression Scale (CES-D), and an abbreviated EDITS (Erectile Dysfunction Inventory of Treatment Satisfaction) questionnaire at least six months after MABS. Questionnaires included both pre- and post-operative evaluation of the subject.
Results: There were statistical improvement between pre- and post-operative IIEF (37.1 vs. 59.8, p<0.05), SDS (36.3 vs. 18.3, p<0.05), and CES-D (41.04 vs. 34.7, p<0.05) scores. Average EDITS score was 18.0 (scored 0-4, maximum score 24, with higher score indicating greater treatment satisfaction. Differences reached statistical significance within the IIEF domains as well, including erectile function (14.4 vs. 25.8, p<0.05), intercourse satisfaction (5.9 vs. 10.2, p<0.05), and overall satisfaction (4.2 vs. 7.6, p<0.05) scores.
Conclusions: MABS should be considered as a therapeutic option in select patients younger than 55 years and free of vascular risk factors with pure cavernosal artery insufficiency. Validated questionnaires comparing pre- and post-operative states demonstrate the ability of MABS to significantly improve erectile function in these well selected patients.