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Condition

Erectile Dysfunction 

Erectile dysfunction is the inability to attain or maintain penile erection sufficient for successful sexual intercourse.

What is Erectile Dysfunction?

Erectile dysfunction is the inability to attain or maintain penile erection sufficient for successful sexual intercourse. ED carries a notable influence on quality of life, with significant implications for family and social relationships.

Although it has been perceived as a multi-factorial problem, combining neurological, psychological, hormonal and vascular disease, it is the inner lining of blood vessel emerging as one of the major factors creating the problem. As recent research suggests, atherosclerotic plaques similar to those in the heart vessels or leg vessels are being formed causing narrowing and blockages of the small arteries which are usually bringing the blood to the penis.

 

Significantly decreased blood flow to the penis causes organ dysfunction, in this case, erectile dysfunction, the inability to perform. And indeed, up to 75% of patients with ED have a significant but treatable stenosis of the iliac-pudendal-penile arteries.

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What Causes ED?

Vascular ED is part of the big family of vascular disease, it just happens that it involves the penis arteries rather than the heart (coronary) arteries or the peripheral arteries of the legs. Therefore, the risk factors are the same:

Medical conditions like:

  • Diabetes

  • High blood pressure

  • High cholesterol

  • Obesity

  • Low testosterone (increases risk of atherosclerosis in general)

Social conditions like:

  • Smoking

  • Sedentary life, lack of physical exercise

  • Genetic predisposition

Erectile dysfunction does not always indicate an underlying heart problem. However, research suggests that men with erectile dysfunction who have no obvious cause, such as trauma, and who have no symptoms of heart problems should be screened for heart disease before starting any treatment.

 

We strongly advise you to see a cardiologist as well. 

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Tests

  • Echo-Doppler ultrasound vascular diagnostics with and without provocation test: The ultrasound test measuring the pelvic and penile arteries.

  • A provocation test may include the injection of vasodilating medication to evaluate the blood flow at rest and during maximum erection. 

  • Angio-CT scan of pelvic and penile arteries: contrast media injection can show the exact location of a vessel narrowing. In certain cases it is necessary to demonstrate the decreased blood flow during erection, which requires again the injection of the vasoactive medication.

Proper, adequate testing is important. The more accurate the diagnosis of vascular disease as the reason for ED, the more likely the therapy will succeed.

 

Our urology team is happy to investigate with you and answer all further questions you may have. 

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Erectile Dysfunction (ED) Treatment

Angiogram and Endovascular Intervention

Restoring normal blood flow to the penis in just one simple procedure.

 

What is the Penile Artery Endovascular Intervention?

The minimally invasive angiogram is a quick and painless endovascular procedure. After accessing the groin artery we inject contrast media into the pelvic and penis arteries. This procedure is the ultimate proof of existing arterial blockages.

 

In case that these narrowings do appear significant in size (> 50% stenosis), we will proceed and re-open the blockage with a drug eluting balloon or drug eluting stent, similar to those used in coronary artery (heart) procedures.

 

In individual cases when technically possible, we may access the wrist artery, allowing shorter post-interventional observational time and discharge home the same day.

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Why would you need a balloon intervention or a stent?

This minimally invasive procedure is an option for patients suffering from erectile dysfunction because of penile artery narrowing.

 

Learn more about erectile dysfunction >

 

The success rate of the procedure is very high in terms of reopening the vessel (> 90%) causing significant improvement of subjective symptoms in 67% of the patients (two thirds). Accurately pre-diagnosed patients are more likely to show significant improvement.

 

All our patients must undergo sufficient diagnostic evaluation prior to the intervention in order to be considered for the invasive angiogram and stenting treatment. 

Possible medical risks

Our ability to use imaging guidance and cutting-edge technology minimizes patient risk. Specific, individual risks will be explained in detail personally during the informed consent consultation. 

Conditions to let us know about

Let your doctor know if you suffer from other cardio-vascular conditions or diabetes, if you are taking any blood thinners and what is your diabetes medication.

Insurance coverage

Penile artery endovascular intervention is covered by most private insurance providers. We will seek authorization from your insurance company prior to your procedure.

Dr. Juan Luis Gutierrez-Chico & Dr. Bern

Preparing for your procedure

If you are on blood thinners your doctor will instruct you if you need to stop these medications prior to the procedure. If your procedure requires sedation, then you will need a responsible adult to give you a ride home.

During the endovascular procedure

General anesthesia is not used for Endovascular interventions. At the most you may be administered a light sedative to make you comfortable. There will be no cut and no wound.

 

After the needle puncture, very thin catheters are navigated to the arteries of interest, the pudendal and penis arteries. Contrast media is injected to visualise possible narrowing inside the vessels. In case your blockage is larger than 50% of the vessel diameter, we will dilate the area with a medication coated balloon or insert a stent to reopen the blockage.

 

Repeat contrast media injection will allow for immediate success control, the blockage will disappear allowing the blood flow to return to normal.

 

The procedure is not painful because the arteries do not have pain receptors.

 

At UroCare we are equipped with the Siemens advanced Syngo Embolization Software and the dynoCT/Cone Beam CT. This allows us more precise and accurate navigation inside the vessels.

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Recovering from your procedure

You may possibly receive mild to moderate sedation during your procedure. If access through the wrist artery was possible, you will stay in the recovery area until you are ready for discharge approx. 5 hours later. In case of access through the groin artery, you will be monitored over night for signs of bleeding from the needle insertion site.

 

In both cases you will be given written post procedure discharge instructions that will advise you about return to normal physical activity. If you have any questions after your procedure, please call CardioCare on (+34) 677 759 003.

After the endovascular intervention

After balloon dilatation or stent placement you will need to take oral anti platelet drugs like Aspirin. This medication is necessary to avoid relapse of the blockage at the treatment site. In case that your site of access via needle puncture was chosen to be the groin, you may need to rest groin mobility for a week after the procedure, avoiding heavy lifting and bending of your hip.

 

Since the blood flow has been restored, you may see a significant improvement of your erectile function shortly after the procedure.

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