Surgical treatment of impotence

Surgery is an effective way to treat patients with sexual dysfunctions. This method of exposure is used in case of low effectiveness of drug and physiotherapeutic treatment.

Diagnosis before surgery

A detailed study of the collected anamnestic information and examination results allows us to identify the diseases present in the patient, preceding the onset of erectile pathology. It is rather difficult for patients suffering from sexual dysfunctions to talk about the identified violations. When interviewing a patient, the urologist must provide a comfortable environment for communication so as not to create stress factors that aggravate the man's well-being.

After collecting the anamnesis, the doctor conducts a detailed examination of the genitals, directs the patient for instrumental (ultrasound, CT and MRI) and laboratory examinations (blood and urine tests). If necessary, the urologist consults with a therapist, endocrinologist, cardiologist and neurologist about the patient's condition.

Questions of the effectiveness of surgical treatment

Surgical intervention is used only for the most complex organic disorders that cause erectile pathology. If the doctor is convinced of the futility of conservative care, then the only way to restore the patient's sexual health is surgery. According to the latest analytical studies, the success of surgical procedures aimed at restoring an erection is increasing. Approximately 60% of patients who have undergone surgery in the perineal region fully restore normal sexual functions. The following common surgical techniques are used to treat impotence.

Penile revascularization

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Microsurgical revascularization is necessary for men suffering from severe vascular lesions. Patients note such pathological signs as:

• insufficient stiffness of the penis
• weakening and short duration of erection
• decrease in the duration of intercourse
• difficulty with an erection

Emergency surgery can be performed after trauma to the penis, which has caused a violation of the integrity of the dorsal vessels. During the operation, the surgeon creates an anastomosis between the dorsal and inferior epigastric arteries. The effectiveness of the described technique is 55-60%.





When genital revascularization is not allowed




Contraindications for performing surgery are such health disorders as:




• chronic renal failure
• diabetes mellitus
• serious vascular disorders
• arterial hypertension
• peripheral vascular disease
• hypercholesterolemia



This method of treating impotence cannot be applied to persons undergoing rehabilitation after radiation therapy of the small pelvis, suffering from nicotine addiction or who have reached the age of 50.





Venous surgery




Methods of venous microsurgery are required to be applied in case of development of erectile dysfunction on the background:




• arterial dysplasia and atherosclerosis
• cavernous insufficiency
• post-traumatic occlusion of the penile arteries
• severe arterial spasms



Surgical intervention has positive results in 50-70% of cases. Fluctuations in the effectiveness of the procedure depend on the patient's condition, the degree of development of pathological phenomena and the qualifications of the doctor performing the operation.





Endofalloprosthetics




This is the most effective method of surgical care, helping to restore normal erection to 90% of patients. Doctors select plastic, inflatable and rigid prostheses for patients. Therapeutic manipulation is performed under general anesthesia. The way the prosthesis is placed depends on the type of implant. Surgeons usually make an incision in the scrotum or below the pubis.





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The implantation of prostheses is recommended in the presence of the following lesions:




• underdevelopment of the penis
• vascular erectile dysfunction
• diabetes mellitus
• severe psychogenic abnormalities
• Peyronie's disease
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• undesirable postoperative consequences that caused changes in the anatomical shape of the penis, as well as disorders of the prostate gland, intestines or bladder




Contraindications




Endophalloprosthetics is prohibited if a man has: