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The Role of Interventional Radiology in the Diagnosis and Management of Male Impotence

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Abstract

Erectile dysfunction (ED) is defined as the persistent inability to reach or maintain penile rigidity enough for sexual satisfaction. Nearly 30% of the men between ages 40 and 70 years are affected by ED. A variety of pathologies, including neurological, psychological, or endocrine disorders and drug side effects, may incite ED. A commonly identified cause of ED is vascular disease. Initial diagnostic workup includes a detailed physical examination and laboratory tests. Whilst duplex ultrasound is considered the first-line diagnostic modality, intra-arterial digital subtraction angiography is still considered the “gold standard” for the diagnosis of arteriogenic impotence. Percutaneous endovascular treatment may be offered in patients with vasculogenic ED that has failed to respond to oral medical therapy as an alternative to penile prosthesis or open surgical repair. In arteriogenic ED balloon angioplasty of the aorto-iliac axis, and in veno-occlusive ED, percutaneous venous ablation using various embolization materials has been reported to be safe and to improve sexual performance. Recently, the ZEN study investigated the safety and feasibility of drug-eluting stents for the treatment of arteriogenic ED attributed to internal pudendal artery stenosis with promising preliminary results. This manuscript highlights the role of interventional radiology in the diagnosis and minimally invasive treatment of male impotence.

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References

  1. NIH Consensus Conference (1993) Impotence. NIH consensus development panel on impotence. JAMA 270(1):83–90

    Article  Google Scholar 

  2. Schwartz BG, Kloner RA (2011) Clinical cardiology: physician update: erectile dysfunction and cardiovascular disease. Circulation 123:98–101

    Article  PubMed  Google Scholar 

  3. Javaroni V, Neves MF (2012) Erectile dysfunction and hypertension: impact on cardiovascular risk and treatment. Int J Hypertens 62:72–78

    Google Scholar 

  4. Lewis RW, Fugl-Meyer KS, Corona G et al (2010) Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 7(4):1598–1607

    Article  PubMed  Google Scholar 

  5. Schwartz BG, Kloner RA (2011) Cardiovascular implications of erectile dysfunction. Circulation 123:e609–e611

    Article  PubMed  Google Scholar 

  6. Hatzimouratidis K, Hatzichristou DG (2005) A comparative review of the options for treatment of erectile dysfunction: which treatment for which patient? Drugs 65:1621–1650

    Article  PubMed  CAS  Google Scholar 

  7. Kayıgil O, Okulu E, Aldemir M et al (2012) Penile revascularization in vasculogenic erectile dysfunction (ED): long-term follow-up. BJU Int 109(1):109–115

    Article  PubMed  Google Scholar 

  8. Albersen M, Orabi H, Lue TF (2012) Evaluation and treatment of erectile dysfunction in the aging male: a mini-review. Gerontology 58:3–14

    Article  PubMed  CAS  Google Scholar 

  9. Andersson KE (2011) Mechanisms of penile erection and basis for pharmacological treatment of erectile dysfunction. Pharmacol Rev 63(4):811–859

    Article  PubMed  CAS  Google Scholar 

  10. Hatzimouratidis K, Amar E, Eardley I et al (2010) Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol 57(5):804–814

    Article  PubMed  Google Scholar 

  11. Rosen RC, Riley A, Wagner G et al (1997) The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 49(6):822–830

    Article  PubMed  CAS  Google Scholar 

  12. Inman BA, Sauver JL, Jacobson DJ et al (2009) A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 84:108–113

    Article  PubMed  Google Scholar 

  13. Grein U, Schubert GE (2002) Arteriosclerosis of penile arteries: histological findings and their significance in the treatment of erectile dysfunction. Urol Int 68:261–264

    Article  PubMed  Google Scholar 

  14. Levine FJ, Greenfield AJ, Goldstein I (1990) Arteriographically-determined occlusive disease within the hypogastric-cavernous bed in impotent patients following blunt perineal and pelvic trauma. J Urol 144:1147–1151

    PubMed  CAS  Google Scholar 

  15. Leriche R (1923) Des Obiterations Arterialles Hautes (Obliteration de Iaterminaison de l’aorte.) Comme cause d’insuffisancecirculatoire des membreinfenieures. Bull Mem Soc Chir Paris 49:404–406 [Article in French]

    Google Scholar 

  16. Liao SL, Luthra M, Rogers KM (2009) Leriche syndrome. J Am Coll Cardiol 54(19):e11

    Article  PubMed  Google Scholar 

  17. Solomon H, Man JW, Jackson G (2003) Erectile dysfunction and the cardiovascular patient: endothelial dysfunction is the common denominator. Heart 89:251–253

    Article  PubMed  CAS  Google Scholar 

  18. Javaroni V, Queiroz-Miguez M, Abreu-Casanova M et al (2011) Brachial flow-mediated dilation correlates with vardenafil response in hypertensive men with vasculogenic erectile dysfunction. Urology 78(2):368–374

    Article  PubMed  Google Scholar 

  19. Esposito K, Giugliano F, Di Palo C et al (2004) Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA 291(24):2978–2984

    Article  PubMed  CAS  Google Scholar 

  20. Rogers JH, Karimi H, Kao J et al (2010) Internal pudendal artery stenoses and erectile dysfunction: correlation with angiographic coronary artery disease. Catheter Cardiovasc Interv 76(6):882–887

    Article  PubMed  Google Scholar 

  21. Azadzoi KM, Goldstein I, Siroky MB et al (1998) Mechanisms of ischemia-induced cavernosal smooth muscle relaxation impairment in a rabbit model of vasculogenic erectile dysfunction. J Urol 160:2216–2222

    Article  PubMed  CAS  Google Scholar 

  22. Azadzoi KM (2006) Vasculogenic erectile dysfunction: beyond the haemodynamic changes. BJU Int 97(1):11–16

    Article  PubMed  Google Scholar 

  23. Mazo EB, Gamidov SI, Iremashvili VV (2006) Does the clinical efficacy of vardenafil correlate with its effect on the endothelial function of cavernosal arteries? A pilot study. BJU Int 98(5):1054–1058

    Article  PubMed  CAS  Google Scholar 

  24. Albersen M, Shindel AW, Mwamukonda KB et al (2010) The future is today: emerging drugs for the treatment of erectile dysfunction. Expert Opin Emerg Drugs 15:467–480

    Article  PubMed  CAS  Google Scholar 

  25. Rajfer J, Rosciszewski A, Mehringer M (1988) Prevalence of corporeal venous leakage in impotent men. J Urol 140:69

    PubMed  CAS  Google Scholar 

  26. Metz P, Ebbehoj J, Uhrenholdt A et al (1983) Peyronie’s disease and erectile failure. J Urol 130:1103

    PubMed  CAS  Google Scholar 

  27. Dalkin BL, Carter MF (1991) Venogenic impotence following dermal graft repair for Peyronie’s disease. J Urol 146:849

    PubMed  CAS  Google Scholar 

  28. Dean RC, Lue TF (2005) Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am 32(4):379–395

    Article  PubMed  Google Scholar 

  29. Huber J, Schild HH, Huber CG et al (2011) A young man with position-dependent erectile dysfunction: diagnostic work-up and interventional therapy of an arteriovenous malformation. Clinics (Sao Paulo) 66(6):1119–1121

    Article  Google Scholar 

  30. Rayt HS, Bown MJ, Lambert KV et al (2008) Buttock claudication and erectile dysfunction after internal iliac artery embolization in patients prior to endovascular aortic aneurysm repair. Cardiovasc Intervent Radiol 31(4):728–734

    Article  PubMed  CAS  Google Scholar 

  31. Zorgniotti AW, Shah WW, Padula G et al (1984) Impotence associated with pudendal arteriovenous malformation. Urol 132:128–130

    CAS  Google Scholar 

  32. Rowe C, Ganick S, Munarriz R (2010) Traumatic vasculogenic erectile dysfunction: role of penile microarterial bypass surgery. Curr Urol Rep 11(6):427–431

    Article  PubMed  Google Scholar 

  33. Golijanin D, Singer E, Davis R et al (2007) Doppler evaluation of erectile dysfunction - part 2. Int J Impot Res 19(1):43–48

    Article  PubMed  CAS  Google Scholar 

  34. Aversa A, Sarteschi LM (2007) The role of penile color-duplex ultrasound for the evaluation of erectile dysfunction. J Sex Med 4(5):1437–1447

    Article  PubMed  Google Scholar 

  35. Teloken PE, Park K, Parker M et al (2011) The false diagnosis of venous leak: prevalence and predictors. J Sex Med 8(8):2344–2349

    Article  PubMed  Google Scholar 

  36. Babaev A, Jhaveri RR (2012) Angiography and endovascular revascularization of pudendal artery atherosclerotic disease in patients with medically refractory erectile dysfunction. J Invasive Cardiol 24(5):236–240

    PubMed  Google Scholar 

  37. John H, Kacl GM, Lehmann K et al (1999) Clinical value of pelvic and penile magnetic resonance angiography in preoperative evaluation of penile revascularization. Int J Impot Res 11(2):83–86

    Article  PubMed  CAS  Google Scholar 

  38. Izumi K, Kawanishi Y, Muguruma H (2011) Virtual cavernoscopy: a novel diagnostic tool for use in the corpus cavernosal lumen in patients with erectile dysfunction. BJU Int 108(8):1316–1320

    Article  PubMed  Google Scholar 

  39. Ahmed M, Chilton CP, Munson KW et al (1998) The role of colour Doppler imaging in the management of Peyronie’s disease. Br J Urol 81(4):604–606

    PubMed  CAS  Google Scholar 

  40. KawanishiY Lee KS, Kimura K et al (2001) Feasibility of multi-slice computed tomography in the diagnosis of arteriogenic erectile dysfunction. BJU Int 88(4):390–395

    Article  Google Scholar 

  41. Bähren W, Gall H, Scherb W et al (1988) Arterial anatomy and arteriographic diagnosis of arteriogenic impotence. Cardiovasc Intervent Radiol 11(4):195–210

    Article  PubMed  Google Scholar 

  42. Kandarpa K, Gardinger GA (2002) Peripheral angiography. In: Kandarpa K, Aruni GE (eds) Handbook of interventional radiologic procedures, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 3–26

    Google Scholar 

  43. Huguet IF, Clerissi J, Juhan C (1981) Radiologic anatomy of pudendal artery. Eur J Radiol 1:278–284

    PubMed  CAS  Google Scholar 

  44. Gray H (1973) Gray’s anatomy of the human body. In:Gross CM (ed) Lea & Febiger, Philadelphia, p 648

  45. Gray R, Keresteci A, St. Louis E et al (1982) Investigation of impotence by internal pudendal angiography: experience with 73 cases. Radiology 144:773–780

    PubMed  CAS  Google Scholar 

  46. Padma-Nathan H, Goldstein I (1986) Corporal leakage syndrome: the role of dynamic infusion cavernosometry and cavernosography. J Urol 137:184–186

    Google Scholar 

  47. Kaufman JM, Borges FD, Fitch WP 3rd et al (1993) Evaluation of erectile dysfunction by dynamic infusion cavernosometry and cavernosography (DICC). Multi-institutional study. Urology 41(5):445–451

    Article  PubMed  CAS  Google Scholar 

  48. Castaneda-Zuniga WR, Smith A, Kaye K et al (1982) Transluminal angioplasty for treatment of vasculogenic impotence. AJR Am J Roentgenol 139:371–373

    Article  PubMed  CAS  Google Scholar 

  49. Flanigan DP, Sobinsky KR, Schuler JJ et al (1985) Internal iliac artery revascularization in the treatment of vasculogenic impotence. Arch Surg 120:271–274

    Article  PubMed  CAS  Google Scholar 

  50. Goldwasser B, Carson CC, Braun SD et al (1985) Impotence due to the pelvic steal syndrome: treatment by iliac transluminal angioplasty. J Urol 133:860–861

    PubMed  CAS  Google Scholar 

  51. Van Unnik JG, Marsman JWP (1984) Impotence due to the external lilac steal syndrome treated by percutaneous transluminal angioplasty. J Urol 13:544–545

    Google Scholar 

  52. Urigo F, Pischedda A, Maiore M et al (1994) Role of arteriography and percutaneous transluminal angioplasty in the diagnosis and treatment of arterial vasculogenic impotence. Radiol Med 88(1–2):86–92

    PubMed  CAS  Google Scholar 

  53. Valji K, Bookstein JJ (1988) Transluminal angioplasty in the treatment of arteriogenic impotence. Cardiovasc Intervent Radiol 11(4):245–252

    Article  PubMed  CAS  Google Scholar 

  54. Gur S, Ozkan U, Onder H et al (2012) The effect of endovascular revascularization of common iliac artery occlusions on erectile function. Cardiovasc Intervent Radiol Feb 23. [Epub ahead of print]

  55. Katsanos K, Spiliopoulos S, Krokidis M et al (2012) Does below-the-knee placement of drug-eluting stents improve clinical outcomes? J Cardiovasc Surg (Torino) 53(2):195–203

    CAS  Google Scholar 

  56. Rocha-Singh K (2012) Erectile dysfunction: prevalence and therapeutic paths. Presented at The Leipzig Interventional Course (LINC), January 25–28, 2012, Leipzig, Germany

  57. Peskircioglu L, Tekin I, Boyvat F et al (2000) Embolization of the deep dorsal vein for the treatment of erectile impotence due to veno-occlusive dysfunction. J Urol 163:472–475

    Article  PubMed  CAS  Google Scholar 

  58. Miwa Y, Shioyama R, Itou Y et al (2001) Pelvic venoablation with ethanol for the treatment of erectile dysfunction due to veno-occlusive dysfunction. Urology 58:76–79

    Article  PubMed  CAS  Google Scholar 

  59. Bookstein JJ, Lurie AL et al (1988) Transluminal penile venoablation for impotence: a progress report. Cardiovasc Intervent Radiol 11:253–260

    Article  PubMed  CAS  Google Scholar 

  60. Basche S, Eger C, Elsebach K et al (2003) Veno-occlusive dysfunction as a cause of erectile impotence: therapy of venous leak with retrograde embolization of the internal pudendal vein. Vasa 32(1):47–50

    Article  PubMed  Google Scholar 

  61. Kutlu R, Soylu A (2009) Deep dorsal vein embolization with N-butyl-2-cyanoacrylate and lipiodol mixture in venogenic erectile dysfunction: early and late results. Radiol Oncol 43(1):17–25

    Article  Google Scholar 

  62. Kutlu R, Soylu A, Alkan A et al (2004) Pulmonary embolism after penile deep dorsal vein embolization with n-butyl-2-cyanoacrylate and lipiodol mixture. Eur J Radiol Extra 49:103–106

    Article  Google Scholar 

  63. Schild HH, Müller SC, Mildenberger P et al (1993) Percutaneous penile venoablation for treatment of impotence. Cardiovasc Intervent Radiol 16(5):280–286

    Article  PubMed  CAS  Google Scholar 

  64. Fowlis GA, Sidhu PS, Jager HR et al (1994) Preliminary report–combined surgical and radiological penile vein occlusion for the management of impotence caused by venous-sinusoidal incompetence. Br J Urol 74(4):492–496

    Article  PubMed  CAS  Google Scholar 

  65. Hellstrom WJ, Montague DK, Moncada I et al (2010) Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med 7:501–523

    Article  PubMed  Google Scholar 

  66. Lue TF, Broderick GA (2007) Evaluation and nonsurgical management of erectile dysfunction and premature ejaculation. In: Campbell-Walsh, Urology, 9th (edn). Amsterdam, Elsevier

  67. Sabri S, Cotton C (1971) Sexual function following aortoiliac reconstruction. Lancet 2:1218–1219

    Article  PubMed  CAS  Google Scholar 

  68. Agrawal V, Minhas S, Ralph DJ (2006) Venogenic erectile dysfunction in Klippel-Trenaunay syndrome. BJU Int 97(2):327–328

    Article  PubMed  Google Scholar 

  69. Rogers JH, Rocha-Singh KJ (2012) Endovascular therapy for vasculogenic erectile dysfunction. Curr Treat Options Cardiovasc Med 14(2):193–202

    Article  PubMed  Google Scholar 

  70. Setter SM, Iltz JL, Fincham JE, Campbell RK, Baker DE (2005) Phosphodiesterase 5 inhibitors for erectile dysfunction. Ann Pharmacother 39(7–8):1286–1295

    Article  PubMed  CAS  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Patras University Hospital, Rion, Greece

    Stavros Spiliopoulos

  2. Department of Radiology, Cambridge University Hospitals NHS Trust, Addenbrooke’s University Hospital, Box 218, Hills Road, Cambridge, CB2 0QQ, UK

    Nadeem Shaida & Miltiadis Krokidis

  3. Department of Radiology, Guy’s and St Thomas’ NHS Trust, London, UK

    Konstantinos Katsanos

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  1. Stavros Spiliopoulos
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  2. Nadeem Shaida
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  3. Konstantinos Katsanos
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  4. Miltiadis Krokidis
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Correspondence to Miltiadis Krokidis.

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Spiliopoulos, S., Shaida, N., Katsanos, K. et al. The Role of Interventional Radiology in the Diagnosis and Management of Male Impotence. Cardiovasc Intervent Radiol 36, 1204–1212 (2013). https://doi.org/10.1007/s00270-012-0520-z

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