ABSTRACT
Patients with arteriogenic erectile dysfunction [ED] caused by traumatic localized arterial lesions can be treated successfully by penile revascularization [PR] surgery. We aimed to determine the subjective and objective outcomes of PR surgery in patients with arteriogenic ED. We searched for relevant publications released up to May 2008 in the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Biological Abstracts. The citation lists of review articles and included trials were also searched. Studies on different operative techniques of PR for men with ED due to traumatic penile arterial lesions were selected. Data on participants' characteristics, study quality, population, intervention, cure, and adverse effects were collected and analyzed. There were 25 studies on comparison of the PR operative techniques. Concerning subjective cure, men younger than 30 years old had better results than older ones [odds ratio, 3.7; 95% confidence interval, 2.2 to 6.4; P=.001]. Venous leak [odds ratio, 1.8; 95% confidence interval, 1.2 to 2.6] and history of smoking [odds ratio, 3.4; 95% confidence interval, 2.2 to 5.6] influenced success rate. Inconsistent measurements of outcomes limited the findings, and none of the studies were randomized controlled trials. Traumatic patients with arteriogenic ED might benefit from PR. Patient selection is vital for a successful outcome. Variations in penile vascular anatomy are also likely to be important when individualizing penile revascularization. In a limited number of highly selected individuals, PR can be successful for the long-term. Randomized controlled trials examining PR techniques are warranted
Subject(s)
Humans , Male , Impotence, Vasculogenic , Meta-Analysis , Treatment OutcomeABSTRACT
Penile amputation is a rare urologic condition for which immediate surgical replantation is warranted. The surgical technique used for repair has been modified and refined. Our aim was to assess the effects of several interventions and management for amputated penis after replantation. We searched the MEDLINE [January 1966 to May 2007], EMBASE [January 1988 to January 2007], CINAHL [January 1982 to January 2007], PsycLIT [January 1984 to January 2007], ERIC [January 1984 to January 2007], and the bibliographic data of relevant articles; hand-searched conference proceedings; and contacted investigators to locate studies. All reported cases of penile replantation were studied. We assessed all titles, abstracts, and extracted data from the articles identified for inclusion. Outcome measures included cosmetic outcomes, acceptability, operative time, restoration of erectile function, sensibility of the glans, and long-term outcomes. Eighty patients had undergone penile replantation. There was considerable variation in the interventions, patients, and outcome measure. The majority of the reported cases in this area continue to be of moderate quality, although more recent cases have been of higher quality in terms of both patients' demographics and surgical techniques. Data were not available in all of the cases for many of the outcomes expected to be reported. There were several important variations in the cases studied. The value of the various microsurgical techniques for replantation of the penis remains uncertain. Meticulous microsurgical techniques by experienced surgeons can reduce skin, urethra, and graft loss complications and produce a functional organ; nonetheless, such complications are still highly prevalent