Purpose: We report our 4–year experience with deep dorsal vein arterialization at 3 years’ follow–up in young patients with pure cavernoocclusive dysfunction as an alternative to penile prosthesis implantation. Materials and Methods: We performed a modified Furlow–Fisher operation (circumflex collaterals are preserved and the deep dorsal venous valves are not disrupted by a stipper) in 25 patients who did not have risk factors such as general arteriosclerosis, coronary heart disease, hypertension, hyperlipidemia and age (over 40 years). Patients with arterial disease diagnosed by Doppler examination were excluded from the study. Also, patients with abnormal penile biothesiometric and electromyographic findings were not included in the study. Beside the subjective and objective evaluation the efficacy of the operation was also assessed retrospectively in 18 patients by telephone according to items 3 (ability to achieve an erection) and 4 (ability to maintain an erection) of the 15–item International Index of Erectile Function (IIEF). Results: With a mean follow–up of 28 months (range 4–42) subjective and objective success rates were 80 and 72% at 1 year’s 75 and 62.5% at 2 years’, and 70 and 60% at 3 years’ follow–up. According to items 3 and 4 of the 15 item IIEF questionnaire the mean postoperative scores reached 1.55–3.44 and 1.33–3.27 for items 3 and 4, respectively (p<0.01). Two patients (8%) showed signs of glans hypervascularization as a major complication and minor complications such as penile skin edema, subdermal hematoma, loss of penile skin sensation and early thrombosis of the anastomosis were found in a total of 8 patients (32%). Conclusions: Deep dorsal vein arterialization is a preferable choice in highly selected young patients as an alternative to penile prosthesis.

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