Rigi10™ Malleable Penile Prosthesis
Also Known As
Microvascular arterial bypass surgery for impotence, Penile arterial bypass, Penile arterial reconstruction
Definition
Penile revascularization, also known as microvascular arterial bypass surgery for impotence, is a surgical procedure designed to restore adequate arterial blood flow to the penis.1 It is similar to a cardiac bypass but performed in the penis.2 The primary purpose of penile revascularization is to treat arteriogenic erectile dysfunction (ED), particularly in younger men who have experienced focal arterial occlusive disease due to blunt pelvic, perineal, or penile trauma.2 The procedure typically involves creating a microvascular anastomosis, where a donor artery (commonly the inferior epigastric artery) is connected to a recipient artery in the penis (often the dorsal penile artery).1 This bypasses the blocked arterial segment, theoretically increasing perfusion pressure to the cavernosal arteries via perforating branches from the dorsal artery, thereby improving erectile function.2
Clinical Context
Penile revascularization is typically considered for healthy men, often younger than 50 years old, who present with erectile dysfunction due to focal arterial occlusion and no evidence of venous leak upon testing.1 The most common causes leading to this specific type of ED are blunt trauma to the perineum or pelvis, or sometimes prolonged bike riding, which can cause focal endothelial injury to the penile arteries.1,2
Patient selection is critical for successful outcomes. Ideal candidates are young men with a history of perineal or pelvic trauma where arteriography reveals a localized common penile artery lesion.1 Patients with generalized vascular pathology are generally poor candidates, as the underlying disease is likely to affect the revascularized segment over time.1
The surgical procedure is highly specialized, requiring expertise in microvascular surgery. It involves dissecting a donor artery, such as the inferior epigastric artery, and anastomosing it to a recipient artery in the penis, like the dorsal penile artery, to bypass the blockage.1 The cut donor artery is carefully brought through the inguinal ring into the scrotum for the microvascular anastomosis.1
Expected outcomes can be excellent with long-term patency and patient satisfaction, provided strict patient selection criteria are adhered to.1 The goal is to restore natural erectile function without reliance on pharmacological aids or devices.2