Summary
Erectile dysfunction (ED) is one of the most common causes of morbidity in male patients,
with a prevalence of 50–60% in men aged 40–70 years. EDs may be caused by physical
or psychological trauma, the former of which may be treatable through surgical intervention.
Physical trauma may be further categorized as vasculogenic, neurogenic, or idiopathic
in nature. Although many patients do not respond well to nonsurgical treatment options,
few opt for surgical intervention. This is likely due to the difficulty of the procedures,
as well as relatively low historical success rates. As such, a systematic review of
the literature was performed to identify novel surgical interventions for ED.
A total of 19 manuscripts were included in this review, representing data of three
minimally invasive approaches to ED treatment and seven novel surgical techniques.
The data revealed compelling evidence in support of microsurgical treatments for ED
– namely, microvascular arterial bypass penile revascularization surgery (MABS) and
cavernous nerve graft reconstruction. Nerve grafts varied, with the use of end-to-side
ilioinguinal, genitofemoral, and sural grafts, all demonstrating high rates of success.
Furthermore, minimally invasive botulinum toxin (BoNT-A) treatment and adipose-derived
stem cell (ADSC) therapy have shown extreme promise in rat models; with BoNT-A treatment
entering phase II human clinical trials this year.
Many of the surgical methods investigated in this review are microsurgical interventions
that demonstrate high rates of success in patients with neurogenic or vasculogenic
ED. As such, microsurgeons are uniquely trained and positioned to be of value to ED
treatment.
Keywords
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Article info
Publication history
Published online: December 26, 2018
Accepted:
December 9,
2018
Received in revised form:
November 10,
2018
Received:
May 31,
2018
Identification
Copyright
© 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
