(237) Penile Revascularization for Arteriogenic Erectile Dysfunction Is Effective Even in Patients with Veno-Occlusive Dysfunction: Is DICC a Dinosaur? II

Introduction Our previous studies have demonstrated that penile revascularization (PR) for arteriogenic erectile dysfunction (ED) leads to gradual recovery of erectile function over time. This suggests that PR remains an important and underappreciated treatment option. Traditionally, the presence of veno-occlusive dysfunction (VOD) determined by dynamic infusion cavernosometry and cavernosography (DICC) has been considered a contraindication for PR. In this study, we re-evaluated the surgical indication for arteriogenic ED by incorporating new insights regarding the role of VOD. Objective To compare the long-term efficacy of penile revascularization in patients with arteriogenic ED with and without VOD. Methods We enrolled 93 young men with arteriogenic ED (median age, 30 years). Based on preoperative DICC findings, patients were classified into the normal DICC group and abnormal DICC group. Preoperative erectile function was assessed following the standard operating procedures of the International Society for Sexual Medicine. PR was performed by anastomosing the inferior epigastric artery to the dorsal penile artery. Treatment success was defined as an International Index of Erectile Function-6 (IIEF-6) score ≥ 24. Results Of the 93 patients, 63 had pure arteriogenic ED and 30 had mixed vasculogenic ED (arterial insufficiency combined with cavernous dysfunction confirmed by DICC). PR successfully restored erectile function in 92.1% of patients with pure arteriogenic ED and 73.8% of those with mixed vasculogenic ED (Kaplan–Meier analysis, log-rank test: no significant difference). The median time to achieve treatment success in 50% of patients was 10.5 months for pure arteriogenic ED and 10.0 months for mixed vasculogenic ED, indicating no delay in recovery among patients with VOD. The degree of cavernous dysfunction had no significant impact on postoperative recovery. Conclusions In young men without systemic comorbidities, penile revascularization can restore erectile function even in the presence of preoperative VOD. These findings indicate that cavernosal tissue, similar to myocardial tissue, possesses the potential for functional recovery once adequate arterial inflow is restored. Therefore, surgical indications for PR should be reconsidered to include selected patients with VOD, and the necessity of routine DICC in preoperative evaluation warrants reappraisal in the modern diagnostic era. Disclosure No