Salvage of end-stage erectile dysfunction using vascularized fibula as autologous implant

Introduction. Patients in whom medical and surgical options for the treatment of erectile dysfunction have failed pose a unique challenge to reconstructive genitourinary surgeons. We report a novel reconstructive option for the treatment of end-stage erectile dysfunction using a microsurgically transferred vascularized fibula as an autologous implant in a patient in whom multiple inflatable prostheses had failed. Technical Considerations. A reconstructive team, consisting of urologic and plastic reconstructive surgeons, transferred a vascularized fibula into the corporeal body in 1 patient to restore sexual function. Using this technique, successful intercourse was achieved by 6 months of follow-up. We describe the surgical technique of autologous implant of a vascularized fibula in the salvage treatment of end-stage erectile dysfunction. Conclusions. Patients with multiple failed inflatable penile implants can present a formidable challenge to reconstructive surgeons with regard to restoring adequate sexual function. The standard approach to the patient after repeated episodes of unsuccessful salvage of penile prosthesis due to infection and/or extrusion is to remove the prosthesis, leaving the patient impotent. Vascularized autologous tissue transfer provides an option to salvage end-stage erectile dysfunction.