Penile Revascularization Surgery
Christopher Faulkner
Southwestern College Abstract
Penile revascularization surgery was first described by Dr. Vaclav Michal in 1973. The common surgical goal is restoring arterial blood flow and perfusion pressure to men with arteriogenic erectile dysfunction.
Penile Revascularization Surgery Penile revascularization surgery is also referred to as microvascular arterial bypass surgery, which is performed on patients suffering from arteriogenic erectile dysfunction. This procedure is similar to a cardiac bypass, but within the penis and it is generally performed on healthy men under the age of 50 with no signs of venous leak upon testing. According to Boston University School of Medicine Sexual …show more content…
It is very important to ensure proper padding and positioning of the blood pressure cuff, to try and prevent any risk of an injury to the ulnar nerve at the elbow. There are also compression devices placed around each calf to minimize any postoperative venous thromboembolic disease. In addition, preoperative antibiotics are given within one hour of skin incision (cefazolin, or vancomycin if allergic). Arteriogram films are also reviewed prior to skin incision to confirm the integrity of the inferior epigastric artery as well as the dorsal penile artery. After the patient has been prepped and draped, a 14-French Foley catheter is placed. A loupe magnification and a headlight are utilized to assist with visualization. A curvilinear 3 cm penoscrotal incision is made opposite of the planned abdominal incision. Using a finger-sweep technique, the surgeon enters the fascia and bluntly exposes the corpus spongiosum and both tunica albuginea. The penis is then everted through this incision and fixed in place with six blunt hooks and a Lone-Star ring retractor, which then exposes the dorsal neurovascular bundle. This approach helps the surgeon to preserve the fundiform ligament, and maintain erect penile length postoperatively. The neurovascular bundle is then exposed and carful dissection is done directly underneath the fundiform ligament. Papaverine hydrochloride irrigation is …show more content…
Then a longitudinal paramedian incision is made in the fascia and the edge of the fascia is grabbed with Kocher clamps and the belly of the rectus muscle is bluntly mobilized. As the muscle belly is rotated the inferior epigastric vessels are identified on the under surface of the muscle. Now, the vessels are encircled with a vessel loop and the inferior epigastric bundle is dissected with blunt dissection up to the level of the umbilicus and down close to its origin off the femoral artery. A Bipolar is used to cauterize arterial branches from the inferior epigastric bundle to the rectus muscles and pelvic sidewall. The superior portion is then clipped with ligaclips and divided, while the inferior epigastric bundle is approximately 16 cm in length. So now the temporary scrotal staples are removed and a long uterine packing forcep is passed from the scrotal incision, underneath the fundiform ligament, through the external ring, through the inguinal canal and out the internal ring. At which point the epigastric bundle is grasped with the uterine packing forcep and is pulled down to lie at the base of the penis. After the vessel is transferred, the abdominal site is inspected to for bleeding. In addition, an On-Q Pain Pump might be used to assist with postoperative