Skip to main content

Advertisement

SpringerLink
Log in

Endovascular Therapy for Vasculogenic Erectile Dysfunction

  • Vascular Disease (H Gornik and E Kim, Section Editors)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Erectile dysfunction (ED) is an important clinical condition that affects a significant proportion of men. Although there are many etiologies for ED, many cases have a vascular basis that is related to inadequate arterial inflow, veno-occlusive dysfunction, or abnormalities in smooth muscle (cavernosal tissue) relaxation. These vascular abnormalities can exist in isolation or combination. Since the advent of phosphodiesterase-5 inhibitor (PDE5i) therapy, the initial management of ED in most cases consists of a brief medical evaluation followed by a trial of PDE5i therapy. However, up to 50% of men have an inadequate response to PDE5i therapy and discontinue therapy. Subsequent therapies for ED are increasingly invasive, including penile injection of vasodilators, vacuum pumps, and penile implants. With increased awareness of ED among clinicians and the growing mechanistic link between ED and atherosclerotic vascular disease, there has been renewed interest in the diagnosis and management of arteriogenic ED. Prior reports in the 1980s described the existence of arterial inflow lesions in patients with ED, and there are a modest number of reports describing the feasibility of revascularization with balloon angioplasty. Despite initial clinical success, enthusiasm for this technique waned, presumably because ED frequently recurred due to restenosis and lack of small vessel endovascular therapies. Recent investigation and the availability of newer tools such as drug-eluting stents have renewed interest in this field. Although conceptually attractive, endovascular therapy for ED presents significant challenges related to unanswered questions such as the prevalence and appropriate diagnostic evaluation of arteriogenic ED, and the safety and feasibility of stent-based therapies in this population. In addition, the evaluation, management, and follow-up of patients with vascular ED require a multi-disciplinary team with specialists in urology, sexual medicine, and vascular medicine. Despite these challenges, the potential for endovascular treatment of these patients remains one of the most exciting areas of investigation in vascular medicine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. Jama. 1993;270:83–90.

    Google Scholar 

  2. Smith KJ, Roberts MS. The cost-effectiveness of sildenafil. Ann Intern Med. 2000;132:933–7.

    PubMed  CAS  Google Scholar 

  3. Willke RJ, Yen W, Parkerson Jr GR, 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.

    Article  PubMed  CAS  Google Scholar 

  4. 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.

    PubMed  CAS  Google Scholar 

  5. McKinlay JB. The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res. 2000;12 Suppl 4:S6–S11.

    Article  PubMed  Google Scholar 

  6. Ansong KS, Lewis C, Jenkins P, Bell J. Help-seeking decisions among men with impotence. Urology. 1998;52:834–7.

    Article  PubMed  CAS  Google Scholar 

  7. Lue TF. Erectile dysfunction. N Engl J Med. 2000;342:1802–13.

    Article  PubMed  CAS  Google Scholar 

  8. Gazzaruso C, Giordanetti S, De Amici E, Bertone G, Falcone C, Geroldi D, Fratino P, Solerte SB, Garzaniti A. Relationship between erectile dysfunction and silent myocardial ischemia in apparently uncomplicated type 2 diabetic patients. Circulation. 2004;110:22–6.

    Article  PubMed  Google Scholar 

  9. Rosen MP, Greenfield AJ, Walker TG, Grant P, Dubrow J, Bettmann MA, Fried LE, Goldstein I. Cigarette smoking: an independent risk factor for atherosclerosis in the hypogastric-cavernous arterial bed of men with arteriogenic impotence. J Urol. 1991;145:759–63.

    PubMed  CAS  Google Scholar 

  10. El-Sakka AI, Morsy AM, Fagih BI, Nassar AH. Coronary artery risk factors in patients with erectile dysfunction. J Urol. 2004;172:251–4.

    Article  PubMed  Google Scholar 

  11. Dong JY, Zhang YH, Qin LQ. Erectile dysfunction and risk of cardiovascular disease meta-analysis of prospective cohort studies. J Am Coll Cardiol. 2011;58:1378–85.

    Article  PubMed  Google Scholar 

  12. Montorsi F, Briganti A, Salonia A, Rigatti P, Margonato A, Macchi A, Galli S, Ravagnani PM, Montorsi P. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol. 2003;44:360–4. discussion 364–5.

    Article  PubMed  Google Scholar 

  13. Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. Jama. 2005;294:2996–3002.

    Article  PubMed  CAS  Google Scholar 

  14. Chiurlia E, D’Amico R, Ratti C, Granata AR, Romagnoli R, Modena MG. Subclinical coronary artery atherosclerosis in patients with erectile dysfunction. J Am Coll Cardiol. 2005;46:1503–6.

    Article  PubMed  Google Scholar 

  15. Campbell HE. Clinical monograph for drug formulary review: erectile dysfunction agents. J Manag Care Pharm. 2005;11:151–71.

    PubMed  Google Scholar 

  16. Hatzichristou D, Goldstein I. Penile microvascular arterial bypass: indications and surgical considerations. Surg Annu. 1993;25(Pt 2):207–29.

    PubMed  Google Scholar 

  17. Bookstein JJ, Valji K, Parsons L, Kessler W. Pharmacoarteriography in the evaluation of impotence. J Urol. 1987;137:333–7.

    PubMed  CAS  Google Scholar 

  18. Mueller SC, von Wallenberg-Pachaly H, Voges GE, Schild HH. Comparison of selective internal iliac pharmaco-angiography, penile brachial index and duplex sonography with pulsed Doppler analysis for the evaluation of vasculogenic (arteriogenic) impotence. J Urol. 1990;143:928–32.

    PubMed  CAS  Google Scholar 

  19. Rosen MP, Greenfield AJ, Walker TG, Grant P, Guben JK, Dubrow J, Bettmann MA, Goldstein I. Arteriogenic impotence: findings in 195 impotent men examined with selective internal pudendal angiography. Young Investigator’s Award. Radiology. 1990;174:1043–8.

    PubMed  CAS  Google Scholar 

  20. Rogers JH, Karimi H, Kao J, Link D, Javidan J, Yamasaki DS, Dolan M, Laird JR, Low RI. Internal pudendal artery stenoses and erectile dysfunction: correlation with angiographic coronary artery disease. Catheter Cardiovasc Interv. 2010;76:882–7.

    Article  PubMed  Google Scholar 

  21. 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.

    Google Scholar 

  22. Arteries of the Pelvis. In: Uflacker R, ed. Atlas of Vascular Anatomy: An Angiographic Approach. 2nd ed: Lippincott Williams & Wilkins; 2007:655–698.

  23. Yamaki K, Saga T, Doi Y, Aida K, Yoshizuka M. A statistical study of the branching of the human internal iliac artery. Kurume Med J. 1998;45:333–40.

    Article  PubMed  CAS  Google Scholar 

  24. Jarow JP, DeFranzo AJ. Long-term results of arterial bypass surgery for impotence secondary to segmental vascular disease. J Urol. 1996;156:982–5.

    Article  PubMed  CAS  Google Scholar 

  25. Bradley WE, Timm GW, Gallagher JM, Johnson BK. New method for continuous measurement of nocturnal penile tumescence and rigidity. Urology. 1985;26:4–9.

    Article  PubMed  CAS  Google Scholar 

  26. Barry JM, Blank B, Boileau M. Nocturnal penile tumescence monitoring with stamps. Urology. 1980;15:171–2.

    Article  PubMed  CAS  Google Scholar 

  27. Zorgniotti AW. Practical diagnostic screening for impotence. Urology. 1984;23:98–102.

    Article  PubMed  CAS  Google Scholar 

  28. Aitchison M, Aitchison J, Carter R. Is the penile brachial index a reproducible and useful measurement? Br J Urol. 1990;66:202–4.

    Article  PubMed  CAS  Google Scholar 

  29. Kaufman JM, Borges FD, Fitch 3rd WP, Geller RA, Gruber MB, Hubbard JG, McKay Jr DL, Tuttle Jr JP, Witten FR. Evaluation of erectile dysfunction by dynamic infusion cavernosometry and cavernosography (DICC). Multi-institutional study. Urology. 1993;41:445–51.

    Article  PubMed  CAS  Google Scholar 

  30. Kropman RF, Schipper J, van Oostayen JA, Lycklama a Nijeholt AA, Meinhardt W. The value of increased end diastolic velocity during penile duplex sonography in relation to pathological venous leakage in erectile dysfunction. J Urol. 1992;148:314–7.

    PubMed  CAS  Google Scholar 

  31. Lue TF, Hricak H, Marich KW, Tanagho EA. Evaluation of arteriogenic impotence with intracorporeal injection of papaverine and the duplex ultrasound scanner. Semin Urol. 1985;3:43–8.

    PubMed  CAS  Google Scholar 

  32. Patel U, Amin Z, Friedman E, Vale J, Kirby RW, Lees WR. Colour flow and spectral Doppler imaging after papaverine-induced penile erection in 220 impotent men: study of temporal patterns and the importance of repeated sampling, velocity asymmetry and vascular anomalies. Clin Radiol. 1993;48:18–24.

    Article  PubMed  CAS  Google Scholar 

  33. Valji K, Bookstein JJ. Diagnosis of arteriogenic impotence: efficacy of duplex sonography as a screening tool. AJR Am J Roentgenol. 1993;160:65–9.

    PubMed  CAS  Google Scholar 

  34. Forsberg L, Ekelund L, Hederstrom E, Olsson AM. Pharmacoangiography of the penile arteries. Urol Radiol. 1988;10:132–5.

    Article  PubMed  CAS  Google Scholar 

  35. Gray RR, Keresteci AG, St Louis EL, Grosman H, Jewett MA, Rankin JT, Provan JL. Investigation of impotence by internal pudendal angiography: experience with 73 cases. Radiology. 1982;144:773–80.

    PubMed  CAS  Google Scholar 

  36. Rosen MP, Walker TG, Greenfield AJ. Arteriography and radiology of impotence. Urol Radiol. 1988;10:136–43.

    Article  PubMed  CAS  Google Scholar 

  37. Goldstein I, Lurie AL, Lubisich JP. Bicycle riding, perineal trauma, and erectile dysfunction: data and solutions. Curr Urol Rep. 2007;8:491–7.

    Article  PubMed  Google Scholar 

  38. Angelini P, Fighali S. Early experience with balloon angioplasty of internal iliac arteries for vasculogenic impotence. Cathet Cardiovasc Diagn. 1987;13:107–10.

    Article  PubMed  CAS  Google Scholar 

  39. Becker GJ, Rowe DM, Holden RW, Dalsing MC, Bendick PJ. Percutaneous transluminal angioplasty for vasculogenic impotence. Indiana Med. 1986;79:256–62.

    PubMed  CAS  Google Scholar 

  40. Castaneda-Zuniga WR, Smith A, Kaye K, Rusnak B, Herrerra M, Miller R, Amplatz K, Weens C, Ketchum D. Transluminal angioplasty for treatment of vasculogenic impotence. AJR Am J Roentgenol. 1982;139:371–3.

    PubMed  CAS  Google Scholar 

  41. Goldwasser B, Carson 3rd CC, Braun SD, McCann RL. Impotence due to the pelvic steal syndrome: treatment by iliac transluminal angioplasty. J Urol. 1985;133:860–1.

    PubMed  CAS  Google Scholar 

  42. Valji K, Bookstein JJ. Transluminal angioplasty in the treatment of arteriogenic impotence. Cardiovasc Intervent Radiol. 1988;11:245–52.

    Article  PubMed  CAS  Google Scholar 

  43. Van Unnik JG, Marsman JW. Impotence due to the external iliac steal syndrome treated by percutaneous transluminal angioplasty. J Urol. 1984;131:544–5.

    PubMed  Google Scholar 

  44. Rosen RC, Cappelleri JC, Gendrano 3rd N. The International Index of Erectile Function (IIEF): a state-of-the-science review. Int J Impot Res. 2002;14:226–44.

    Article  PubMed  CAS  Google Scholar 

  45. O’Keefe JH, Carter MD, Lavie CJ. Primary and secondary prevention of cardiovascular diseases: a practical evidence-based approach. Mayo Clin Proc. 2009;84:741–57.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of California, Davis Medical Center, 4860 Y Street, Suite #2820, Sacramento, CA, 95817, USA

    Jason H. Rogers MD

  2. Prairie Vascular Institute at St. John’s Hospital, 401 E. Carpenter Street, Springfield, IL, 62702, USA

    Krishna J. Rocha-Singh MD

Authors
  1. Jason H. Rogers MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Krishna J. Rocha-Singh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jason H. Rogers MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rogers, J.H., Rocha-Singh, K.J. Endovascular Therapy for Vasculogenic Erectile Dysfunction. Curr Treat Options Cardio Med 14, 193–202 (2012). https://doi.org/10.1007/s11936-012-0171-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-012-0171-z

Keywords

Search

Navigation