Review| Volume 72, ISSUE 4, P532-538, April 2019

Emerging nonsurgical and surgical techniques to treat erectile dysfunction: A systematic review of treatment options and published outcomes

  • Orr Shauly
    Department of Plastic and Reconstructive Surgery, University of Southern California, Keck Hospital of USC, 1510 San Pablo Street, Suite 4000, Los Angeles, CA 90033, United States
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  • Daniel J. Gould
    Department of Plastic and Reconstructive Surgery, University of Southern California, Keck Hospital of USC, 1510 San Pablo Street, Suite 4000, Los Angeles, CA 90033, United States
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  • Ketan M. Patel
    Corresponding author: Dr. Ketan M. Patel, 1510 San Pablo Street, Suite 415, Los Angeles CA, 90033, Phone: 323-442-7920.
    Department of Plastic and Reconstructive Surgery, University of Southern California, Keck Hospital of USC, 1510 San Pablo Street, Suite 4000, Los Angeles, CA 90033, United States
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Published:December 26, 2018DOI:


      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.


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