Endovascular penile revascularization improves erectile dysfunction in patients with penile arterial insufficiency
DOI:
https://doi.org/10.18203/2349-2902.isj20241161Keywords:
Atherosclerosis, Balloon angioplasty, Drug-coated balloon, Drug-eluting stent, Endovascular revascularization, Erectile dysfunction, Penile arterial insufficiencyAbstract
In most institutions, patients with erectile dysfunction due to penile arterial insufficiency are offered palliative treatments like vacuum constrictor devices, intraurethral alprostadil, intracavernosal injection of prostaglandins, and/or implantation of penile prosthesis when these patients can be treated by endovascular penile revascularization. 50% of patients with erectile dysfunction are non-responders to phosphodiesterase-5 inhibitors. 70% of non-responders to phosphodiesterase-5 inhibitors have penile arterial insufficiency that can be treated with endovascular penile revascularization. Patients who are non-responders to phosphodiesterase-5 inhibitors should be screened for penile arterial insufficiency using penile duplex scan. If penile artery peak systolic velocity is <35 cm/s, then arterial insufficiency is suspected, and computed tomography (CT) angiogram is obtained to confirm presence of significant stenosis in iliac-pedundle-penile arterial system. Patients with penile arterial insufficiency should be offered endovascular penile revascularization. This minimally invasive procedure has minimal perioperative complications (<1%) and has significant clinical improvement in erectile function in >60% of patients at 12 months. Endovascular penile revascularization is safe and has long term clinical improvement in erectile function. This minimally invasive procedure can result in improved erectile function and preserves penile size and shape in most non-responders to phosphodiesterase-5 inhibitors.
Metrics
References
Rogers JH, Goldstein I, Kandzari DE, Köhler TS, Stinis CT, Wagner PJ, et al. Zotarolimus-eluting peripheral stents for the treatment of erectile dysfunction in subjects with suboptimal response to phosphodiesterase-5 inhibitors. J Am Coll Cardiol. 2012;60(25):2618-27.
Mohan V, Schönhofen J, Hoppe H, Schumacher M, Keo HH, Bechir M, et al. Long-Term Outcomes of Drug-Eluting Stent Implantation for Patients With Atherosclerotic Erectile Dysfunction not Responding to PDE-5-Inhibitors. J Endovasc Ther. 2023;15266028231183775.
Diehm N, Marggi S, Ueki Y, Schumacher D, Keo HH, Regli C, et al. Endovascular Therapy for Erectile Dysfunction-Who Benefits Most? Insights From a Single-Center Experience. J Endovasc Ther. 2019;26(2):181-90.
Diehm N, Borm AK, Keo HH. Interdisciplinary options for diagnosis and treatment of organic erectile dysfunction. Swiss Med Wkly. 2015;145:w14268.
Wang TD. Commentary: Angioplasty of Internal Pudendal and Penile Arteries for Arteriogenic Erectile Dysfunction: Reassuring, but the Jury Is Still Out. J Endovasc Ther. 2018;25(6):716-8.
Schönhofen J, Räber L, Knöchel J, Keo HH, Regli C, Kostal F, et al. Endovascular Therapy for Arteriogenic Erectile Dysfunction With a Novel Sirolimus-Eluting Stent. J Sex Med. 2021;18(2):315-26.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61.
Burnett AL, Nehra A, Breau RH, Culkin DJ, Faraday MM, Hakim LS, et al. Erectile Dysfunction: AUA Guideline. J Urol. 2018;200(3):633-41.
Rosenov A, Mertineit N, Baumgartner I, Schindewolf M. Cone-Beam CT-assisted navigation for endovascular treatment of erection-related artery stenosis in patients with erectile dysfunction. CVIR Endovasc. 2022;5(1):41.
Solomon H, Man JW, Jackson G. Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart. 2003;89(3):251-3.
Wang TD, Lee WJ, Chen WJ. Prevalence and distribution of obstructive pelvic arterial lesions by computed tomographic angiography in 476 patients with erectile dysfunction: Implications for endovascular therapy [abstract]. J Am Coll Cardiol. 2015;66:B32.
Shishehbor MH, Philip F. Endovascular treatment for erectile dysfunction: an old paradigm revisited. J Am Coll Cardiol. 2012;60:2628-30.
Diehm N, Pelz S, Kalka C, Keo HH, Mohan V, Schumacher MC, et al. Venous Leak Embolization in Patients with Venogenic Erectile Dysfunction via Deep Dorsal Penile Vein Access: Safety and Early Efficacy. Cardiovasc Intervent Radiol. 2023;46(5):610-16.
Chung E. Penile prosthesis implant: Scientific advances and technological innovations over the last four decades. Transl. Androl Urol. 2017;6:37-45.
Wang CM, Wu BR, Xiang P, Xiao J, Hu XC. Management of male erectile dysfunction: From the past to the future. Front. Endocrinol. 2023;14:1148834.
Lee DJ, Najari BB, Davison WL, Al Hussein Al Awamlh B, Zhao F, Paduch DA, et al. Trends in the utilization of penile prostheses in the treatment of erectile dysfunction in the United States. J Sex Med. 2015;12:1638-45.
Gazzaruso C, Giordanetti S, De AE. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation. 2004;110:22-6.
Araujo AB, Hall SA, Ganz P, Chiu GR, Rosen RC, Kupelian V, et al. Does erectile dysfunction contribute to cardiovascular disease risk prediction beyond the Framingham risk score? J Am Coll Cardiol. 2010;55(4):350-6.
Willke RJ, Yen W, Parkerson GR Jr, Linet OI, Erder MH, Glick HA. Quality of life effects of alprostadil therapy for erectile dysfunction: results of a trial in Europe and South Africa. Int J Impot Res. 1998;10:239-46.
Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151:54-61.
Leriche R. Des obliterations arterielle hautes (oblideration de la termination de l’aorte) comme cause de insufficances circulatoire des membres inferiurs (abstr). Bull Mem Soc Chir. 1923;49:1404.
Philip F, Shishehbor MH. Current state of endovascular treatment for vasculogenic erectile dysfunction. Curr Cardiol Rep. 2013;15(5):360.
May AG, DeWeese JA, Rob CG. Changes in sexual function following operation on the abdominal aorta. Surgery. 1969;65:41-7.
Gür S, Oguzkurt L, Kaya B, Tekbas G, Ozkan U. Impotence due to external iliac steal syndrome: treatment with percutaneous transluminal angioplasty and stent placement. Korean J Radiol. 2013;14(1):81-5.
Van Unnik JG, Marsman JW. Impotence due to the external iliac steal syndrome treated by percutaneous transluminal angioplasty. J Urol. 1984;131:544-5.
Goldwasser B, Carson 3rd CC, Braun SD. Impotence due to the pelvic steal syndrome: treatment by iliac transluminal angioplasty. J Urol. 1985;133:860-1.
Rayt HS, Bown MJ, Lambert KV, Fishwick NG, McCarthy MJ, London NJ, et al. Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol. 2008;31(4):728-34.
Lin PH, Bush RL, Lumsden AB. Sloughing of the scrotal skin and impotence subsequent to bilateral hypogastric artery embolization for endovascular aortoiliac aneurysm repair. J Vasc Surg. 2001;34(4):748-50.
Wang TD, Lee CK, Chia YC, Tsoi K, Buranakitjaroen P, Chen CH, et al. Hypertension and erectile dysfunction: The role of endovascular therapy in Asia. J Clin Hypertens (Greenwich). 2021;23(3):481-8.
Aversa A, Crafa A, Greco EA, Chiefari E, Brunetti A, La Vignera S. The penile duplex ultrasound: How and when to perform it? Andrology. 2021;9(5):1457-66.
Meller SM, Stilp E, Walker CN, Mena-Hurtado C. The link between vasculogenic erectile dysfunction, coronary artery disease, and peripheral artery disease: role of metabolic factors and endovascular therapy. J Invasive Cardiol. 2013;25(6):313-9.
Rosen RC, Cappelleri JC, Gendrano N III. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res. 2002;14:226-4.
Wang TD, Lee WJ, Yang SC, Lin PC, Tai HC, Hsieh JT, et al. Safety and six-month durability of angioplasty for isolated penile artery stenoses in patients with erectile dysfunction: a first-in-man study. Euro Intervention. 2014;10(1):147-56.
Wang TD, Lee WJ, Yang SC, Lin PC, Tai HC, Liu SP, et al. Clinical and Imaging Outcomes up to 1 Year Following Balloon Angioplasty for Isolated Penile Artery Stenoses in Patients With Erectile Dysfunction: The PERFECT-2 Study. J Endovasc Ther. 2016;23(6):867-77.
Wang TD, Lee WJ, Chen WJ. A randomized comparison among drug-eluting balloon, drug-eluting stents, and conventional balloon angioplasty for lesions in the distal internal pudendal artery in patients with erectile dysfunction—the PERFECT-3 study. Paper presented at: TCT, San Francisco, CA, USA. 2015. Available at: https://www.tctmd. com/slide/randomized-comparison-among-drug-eluting-balloon-drug-eluting-stents-and-conventional-balloon. Accessed on 09 January 2024.
Wang TD, Lee WJ, Lin PC. A randomised comparison between drug-eluting balloon and conventional balloon angioplasty for lesions in the penile artery in patients with erectile dysfunction: the PERFECT-4 study. Paper presented at: EuroPCR, Paris, France. 2016. Available at: https://www. tctmd.com/slide/randomised-comparison-between-drug-eluting-balloon-and-conventional-balloon-angioplasty. Accessed on 09 January 2024.
Hoppe H, Diehm N. To the editor-an update on endovascular treatment of venogenic erectile dysfunction. CVIR Endovasc. 2022;5(1):30.
Sussman H, Labastie MN, Hauet P, Allaire E, Lombion S, Virag R. Ultrasonography after pharmacological stimulation of erection for the diagnosis and therapeutic follow-up of erectile dysfunction due to cavernovenous leakage. J Med Vasc. 2020;45(1):3-12.
Doppalapudi SK, Wajswol E, Shukla PA, Kolber MK, Singh MK, Kumar A, et al. Endovascular Therapy for Vasculogenic Erectile Dysfunction: A Systematic Review and Meta-Analysis of Arterial and Venous Therapies. J Vasc Interv Radiol. 2019;30(8):1251-8.
Hoppe H, Hirschle D, Schumacher MC, Schönhofen H, Glenck M, Kalka C, et al. Erectile dysfunction: role of computed tomography cavernosography in the diagnosis and treatment planning of venous leak. CVIR Endovasc. 2023;6(1):56.
