Endovascular Therapy for Erectile Dysfunction—Who Benefits Most? Insights From a Single-Center Experience

Abstract

Purpose: To report the 1-year outcomes of a single-center, all-comers registry aimed to assess effectiveness and safety of endovascular revascularization for atherosclerotic erectile dysfunction (ED) in an unselected patient cohort. Materials and Methods: Between April 2016 and October 2017, 50 consecutive patients (mean age 59.6±10.3 years) underwent endovascular revascularization for ED owing to >50% stenosis in 82 erection-related arteries. Patients were treated by means of standard balloon angioplasty (16%), drug-coated balloon angioplasty (27%), or drug-eluting stent (55%) implantation. The primary feasibility outcome measure was the incidence of a minimum clinically relevant improvement of ≥4 in the 6-question International Index of Erectile Function Questionnaire (IIEF-6) score at 12 months. Clinical effectiveness was improvement in erectile function as quantified in the mean difference (MD) of the IIEF-15 score at 3 and 12 months as well as the mean changes in IIEF-15 questions 3 and 4. Results: Procedure success was achieved in 49 (98%) of 50 patients. At 12 months, 30 (65%) of 46 patients achieved a minimum clinically relevant improvement in the IIEF-6 score. The overall IIEF-15 score, as well as scores for questions 3 and 4, improved in 32 (65%) of 49 patients, 28 (57%) of 49 patients, and 29 (60%) of 48 patients, respectively. Change in the overall IIEF-15 score at 12 months was consistent among subgroups, except for elderly patients [MD −5.0 (95% CI −9.7 to −0.2), p=0.041] and those with hypertension [MD −11.0 (95% CI −20.5 to −1.5), p=0.025], who showed less improvement. Conclusion: Endovascular revascularization was safe and efficacious in the majority of ED patients through 1 year.

A case report of pudendal arteries angioplasty with sirolimus drug-coated balloon and drug-eluting stent associated with intracavernous autologous peripheral blood mononuclear cells injection for untreatable vasculogenic erectile dysfunction

“… 3 Therefore, mechanical revascularization of the internal pudendal and dorsalis penis arteries has been proposed in patients who are not responsive to oral PDE5i. 8–12 …”

“…A Swiss group reported the 1-year outcomes in 50 consecutive patients affected by erectile dysfunction and internal pudendal artery (IPA) stenosis. 8 Patients were treated employing standard balloon angioplasty (16%), drug-coated balloon (DCB, 27%), or drug-eluting stent (DES, 55%) implantation. Procedure success was achieved in 49 (98%) of 50 patients.…”

“…At 12 months, 30 (65%) of 46 patients achieved a minimum of clinically relevant improvement in the International Index of Erectile Function Questionnaire score (IIEF). 8 …”

Percutaneous Treatment of Venous Erectile Dysfunction

“…Most studies have shown an increase in the prevalence of vasculogenic erectile dysfunction with aging (7,10). Therefore, Wespes et al hypothesize that the erectile dysfunction of aging may be the result of atherosclerosis-induced cavernosal ischaemia leading to cavernosal fibrosis and subsequent venoocclusive dysfunction concluding that erectile dysfunction due to aging appears to be a slowly progressive disorder and that it may be wise for patients to seek medical intervention earlier rather than later (11).…”

Modern Endovascular Treatment Methods for Erectile Dysfunction: A Critical Analysis

“…There was shown in some publications that arterial endovascular treatments could contribute to improvement in 63%-65% cases [13,14]. This paper aims at attempting to systematize the knowledge of the benefits and drawbacks of nonsurgical endovascular treatment methods for erectile dysfunction with confirmed vascular causes.…”