Introduction: Micro-surgical revascularization of the penis after a pelvic fracture urethral injury (PFUI) has been proposed to recover erections and / or to improve the irrigation of the spongiosum prior to urethroplasty, aiming to prevent ischemic failure of the reconstruction. Methods: Patients who lost their erection after a PFUI were studied with color Doppler ultrasound of the cavernous arteries after intracavernous injection of prostaglandin. Those diagnosed with arteriogenic erectile dysfunction were confirmed with a selective pudendal pharmaco-arteriography (with intracavernous prostaglandin) and were offered a micro-surgical penile revascularization by means of a bypass of the inferior epigastric artery to the dorsal artery of the penis. Results: Between April 1990 and July 2022, 16 patients were revascularized before urethroplasty. All were acutely managed by suprapubic cystostomy without realigment. The median age was 32 years (range 20-57), the median time between the accident and revascularization was 9 months (range 2-30) and the median time between revascularization and urethroplasty was 2 months (range 1-7). The mean surgical time was 280 min (220-290), with no intraoperative complications. There were 2 Clavien I postoperative complications and one Clavien II. With a median follow-up of 102 months (range 3-367), no patient presented urethroplasty stricture failure and no patient recovered erections despite bypass patency (verified by postoperative Doppler ultrasound in 11). Conclusions: Micro-surgical revascularization of the penis is feasible and safe, requires expertise in micro surgery and does not seem to have a role in recovering erections after PFUI. On the other hand, long-segment ischemic stricture failure is an infrequent but catastrophic complication of urethral reconstruction linked to post traumatic penile arterial insufficiency. In this setting, penile revascularization may contribute to increase urethral blood flow and may be valuable to prevent ischemic failure of the urethral reconstruction. SOURCE OF Funding: None
