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Revascularization surgery to correct most arterial problems represents a major medical procedure, and is still at an early stage of development. One approach has been attempting to bypass the area where the critical arteries are blocked or are too narrow to permit adequate flow of blood to the penis. The bypass approach would be potentially most useful in treating impotence caused by arteriosclerosis. Unfortunately, this approach has not proven, to date, highly successful. One of the problems has been that just installing a bypass in one critical area will not eliminate the effect of arterial disease in the many small vessels supplying the penis. It should also be noted that bypasses installed in coronary arterial bypass surgery have been found to often close spontaneously within a period of ten years. This has led to a certain degree of current concern as to the effectiveness of coronary bypasses in the treatment of heart disease. The situation with regard to penile arterial bypasses is somewhat more discouraging: closure can take place in as few as six months.Greater success has been achieved in the surgical removal of lesions impeding blood flow. Such lesions are usually caused by physical injury and represent a frequent cause of impotence in younger men.
In general, vascular surgery is recommended only for highly selected patients. Only an estimated 5 percent of all men with erectile dysfunction are considered good candidates for the procedures available at the present time. A very specialized person is needed to perform the surgery, not the typical general urologist. Complications are possible, including infection, penile scarring, and painful erections. There is also evidence of a high rate of recurrence of impotence after surgery. Fortunately, when surgery does not prove successful, alternative impotence treatments are still available, including the installation of an implant. Nevertheless, significant strides are being made in the surgical treatment of impotence, and surgical solutions to impotence can be expected to grow in importance in the future.