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Endovascular treatment of vasculogenic erectile dysfunction.

Kim ED, Owen RC, White GS, Elkelany OO, Rahnema CD - Asian J. Androl. (2014)

Bottom Line: Comparatively, endovascular embolization as an approach to correct veno-occlusive dysfunction has produced astonishing procedural success rates as well.Short-term functional outcomes are less than optimal with long-term results yet to be determined.In conclusion, the hope for a minimally invasive approach to ED persists but additional investigation is required prior to universal endorsement.

View Article: PubMed Central - PubMed

Affiliation: University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.

ABSTRACT

The treatment of erectile dysfunction (ED) has been a fascination involving multiple medical specialities over the past century with urologic, cardiac and surgical experts all contributing knowledge toward this multifactorial disease. With the well-described association between ED and cardiovascular disease, angiography has been utilized to identify vasculogenic impotence. Given the success of endovascular drug-eluting stent (DES) placement for the treatment of coronary artery disease, there has been interest in using this same technology for the treatment of vasculogenic ED. For men with inflow stenosis, DES placement to bypass arterial lesions has recently been reported with a high technical success rate. Comparatively, endovascular embolization as an approach to correct veno-occlusive dysfunction has produced astonishing procedural success rates as well. However, after a thorough literature review, arterial intervention is only recommended for younger patients with isolated vascular injuries, typically from previous traumatic experiences. Short-term functional outcomes are less than optimal with long-term results yet to be determined. In conclusion, the hope for a minimally invasive approach to ED persists but additional investigation is required prior to universal endorsement.

No MeSH data available.


Related in: MedlinePlus

Left panel: Atherosclerotic narrowing in the internal pudendal artery resulting in poor arterial inflow and ED with suboptimal filling of penile cavernosal tissue. Right panel: Improved arterial inflow after implantation of a zotarolimus-eluting peripheral stent system. This figure is reproduced with permission from Rogers et al.14
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Figure 2: Left panel: Atherosclerotic narrowing in the internal pudendal artery resulting in poor arterial inflow and ED with suboptimal filling of penile cavernosal tissue. Right panel: Improved arterial inflow after implantation of a zotarolimus-eluting peripheral stent system. This figure is reproduced with permission from Rogers et al.14

Mentions: The Zotarolimus-Eluting Peripheral Stent System (Medtronic, Minneapolis MN, USA) for the treatment of ED in males with sub-optimal response to PDE5 inhibitors (ZEN) trial, published in 2012,8 was the first trial of DES for the treatment of ED. While recruitment methods were not reported, 383 subjects were screened, and those with an International Index of Erectile Function 6 (IIEF-6) baseline of < 22 proceeded to a 4 week run-in phase. The authors describe the use of the IIEF-6 score, which is a modified IIEF, that takes six questions from the IIEF that have the highest discriminating power to diagnose ED.13 The run-in phase consisted of a 4 weeks trial of PDE5i and a required minimum of four sexual encounters. At the end of the run-in phase, patients with IIEF-6 scores remaining < 22 who reported ED for 50% or more of their sexual encounters were screened by penile Doppler ultrasound and those with adequate systolic velocity as well as those with venous leak were excluded from the trial. Invasive penile angiography criteria were designed to include patients with unilateral or moderate to severe bilateral stenosis of the IPA. Patients with ≥ 70% stenosis of non-IPA erectile-related arteries were excluded. Ultimately 30 out of 383 screened subjects (7.8%) were enrolled in the trial (Figure 2)14 – procedural success was 100%, and no adverse events were reported at 30 days.


Endovascular treatment of vasculogenic erectile dysfunction.

Kim ED, Owen RC, White GS, Elkelany OO, Rahnema CD - Asian J. Androl. (2014)

Left panel: Atherosclerotic narrowing in the internal pudendal artery resulting in poor arterial inflow and ED with suboptimal filling of penile cavernosal tissue. Right panel: Improved arterial inflow after implantation of a zotarolimus-eluting peripheral stent system. This figure is reproduced with permission from Rogers et al.14
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4291874&req=5

Figure 2: Left panel: Atherosclerotic narrowing in the internal pudendal artery resulting in poor arterial inflow and ED with suboptimal filling of penile cavernosal tissue. Right panel: Improved arterial inflow after implantation of a zotarolimus-eluting peripheral stent system. This figure is reproduced with permission from Rogers et al.14
Mentions: The Zotarolimus-Eluting Peripheral Stent System (Medtronic, Minneapolis MN, USA) for the treatment of ED in males with sub-optimal response to PDE5 inhibitors (ZEN) trial, published in 2012,8 was the first trial of DES for the treatment of ED. While recruitment methods were not reported, 383 subjects were screened, and those with an International Index of Erectile Function 6 (IIEF-6) baseline of < 22 proceeded to a 4 week run-in phase. The authors describe the use of the IIEF-6 score, which is a modified IIEF, that takes six questions from the IIEF that have the highest discriminating power to diagnose ED.13 The run-in phase consisted of a 4 weeks trial of PDE5i and a required minimum of four sexual encounters. At the end of the run-in phase, patients with IIEF-6 scores remaining < 22 who reported ED for 50% or more of their sexual encounters were screened by penile Doppler ultrasound and those with adequate systolic velocity as well as those with venous leak were excluded from the trial. Invasive penile angiography criteria were designed to include patients with unilateral or moderate to severe bilateral stenosis of the IPA. Patients with ≥ 70% stenosis of non-IPA erectile-related arteries were excluded. Ultimately 30 out of 383 screened subjects (7.8%) were enrolled in the trial (Figure 2)14 – procedural success was 100%, and no adverse events were reported at 30 days.

Bottom Line: Comparatively, endovascular embolization as an approach to correct veno-occlusive dysfunction has produced astonishing procedural success rates as well.Short-term functional outcomes are less than optimal with long-term results yet to be determined.In conclusion, the hope for a minimally invasive approach to ED persists but additional investigation is required prior to universal endorsement.

View Article: PubMed Central - PubMed

Affiliation: University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.

ABSTRACT

The treatment of erectile dysfunction (ED) has been a fascination involving multiple medical specialities over the past century with urologic, cardiac and surgical experts all contributing knowledge toward this multifactorial disease. With the well-described association between ED and cardiovascular disease, angiography has been utilized to identify vasculogenic impotence. Given the success of endovascular drug-eluting stent (DES) placement for the treatment of coronary artery disease, there has been interest in using this same technology for the treatment of vasculogenic ED. For men with inflow stenosis, DES placement to bypass arterial lesions has recently been reported with a high technical success rate. Comparatively, endovascular embolization as an approach to correct veno-occlusive dysfunction has produced astonishing procedural success rates as well. However, after a thorough literature review, arterial intervention is only recommended for younger patients with isolated vascular injuries, typically from previous traumatic experiences. Short-term functional outcomes are less than optimal with long-term results yet to be determined. In conclusion, the hope for a minimally invasive approach to ED persists but additional investigation is required prior to universal endorsement.

No MeSH data available.


Related in: MedlinePlus