Percutaneous angioplasty of internal pudendal arteries in the treatment of erectile dysfunction not responsive to pharmacological therapy. Our initial experience in five patients
Migliorini, F1; Tafuri, A1; Inverardi, D1; Sebben, M1; Ribichini, F2; Artibani, W1
1: Urology Department University Hospital, Italy; 2: Cardiology Department University Hospital, Italy
Objective: To assess the efficacy of percutaneous angioplasty of internal pudendal arteries (IPA) stenosis with medicated balloons in the treatment of erectile dysfunction (ED) no longer responding to pharmacotherapy.
Material and Methods: We enrolled five patients with severe ED no longer responsive to oral and intracavernosal pharmacotherapy. The mean age was 62 ± 5 years old. Serum testosteron and prolactin levels were normal in all patients, IIEF-5 ranged between 3 and 7 (mean 4.6). The penile dynamic color duplex doppler ultrasound (D-CDDU) detected arteriogenic ED with systolic peak velocity (PSV) between 18 and 25 cm/sec (mean 22.2); in all patients penile rigidity was grade 1 on 4 according to Erection Hardness Score. Through a single or bilateral femoral percutaneous access, patients underwent angiography of internal iliac arteries and IPA. Hemodynamically significant stenosis of IPA were observed bilaterally in four patients and unilaterally in one. Stenosis were dilated with a 2.5 x 30 mm medicated balloons. Patients were discharged after one day on double antiplatelet therapy (clopidogrel 75 mg + ASA 100 mg) and atorvastatin 40 mg die.
Results: All procedures were successful with restoring of good IPA flow. No complications have been described. Patients were followed at 4 and 8 months. At the first check all patient reported a significant improvement in erections with an average increase of 9 points in the IIEF-5. Two patients had to assume sildenafil 100 mg and three 50 mg to have good erections. D-CDDU detected an average increase of 13 cm/sec in PSV. At eight months, one patient was regressed at the initial state and underwent prosthesis placement, one patient had to use intracvernosal alprostadil 10 ugr and three were stable with satisfactory erections using Sildenafil 50 mg.
Conclusions: IPA stenosis angioplasty with medicated balloons seems to be a very promising therapy for ED not responsive to pharmacotherapy. It is a safe and repeatable procedure, leads to improvement of erectile function in a significant percentages of cases and can be considered the last therapeutic opportunity before proposing a penile prosthesis.
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