Erectile dysfunction is a persistent inability to achieve or maintain a penial erection for a sufficiently long time for sexual intercourse. It affects over 30 million men worldwide and is most common among men of age above 50 years. It can be caused by several reasons that, include diabetes, psychological issues, and nervous system disorders, but by far, the most common cause of erectile dysfunction is vascular diseases.
Vascular diseases refer to any condition affecting the body’s circulatory system. Vascular disorders can lead to erectile dysfunction in many ways depending upon whether the disease is related to arteries or veins.
During sexual arousal, blood must flow into the corpus cavernosum and stay there to maintain the erection. Still, any disease related to blood vessels can disrupt the supply and sustained hold of blood in the penis, causing the loss of erection.
One of the most common diseases is atherosclerosis, a buildup of fats, cholesterol, and other substances on the walls of arteries. This buildup is called plaque and causes arteries to become narrow, disrupting the blood flow to the genitals, which can lead to erectile dysfunction.
Another primary vascular disease that can cause erectile dysfunction is soft glans venous leak. It is caused by excessive leakage of blood from the penis due to veins not constricting enough despite sufficient arterial blood flow, which prevents a normal penile erection. Various factors, including trauma to the penis, prolonged erections, and certain medications, can cause soft glans venous leak.
Vascular disease can also lead to serious health problems like heart disease and stroke. Men with ED need to be evaluated for underlying vascular disease, as early detection and treatment can help prevent these complications. Men with ED are more likely to have the underlying vascular disease than men without ED.
Vascular Disease VS Erectile Dysfunction
The link between ED and vascular disease highlights the importance of lifestyle factors in developing both conditions. Both risk factors include smoking, high blood pressure, high cholesterol, and diabetes. Making lifestyle changes, such as quitting smoking, eating a healthy diet, and exercising regularly, can help reduce the risk of developing ED and vascular disease.
To diagnose the underlying cause of erectile dysfunction, doctors take a medical history test, perform a physical examination, and conduct hormonal tests, urine tests, blood tests, and penile doppler ultrasound tests.
How to treat Erectile Dysfunction
Treatment options for ED and vascular disease vary depending on the underlying cause. For example, a procedure called penile revascularization can be used to improve blood flow to the penis.
This procedure involves rerouting blood flow to the penis by connecting a healthy artery to the affected artery. Penile implant surgery is another option for men with ED who do not respond to other treatments. It involves placing a device inside the penis to help achieve an erection. Other treatments for ED caused by vascular disease include vacuum erection devices and self-injection therapy. These treatments create an erection by increasing blood flow to the penis.
Medications, such as phosphodiesterase type 5 inhibitors (PDE5 inhibitors), can effectively treat ED caused by reduced blood flow to the penis. These medications work by relaxing the blood vessels and increasing blood flow to the penis.
However, all the above-mentioned treatment options are invasive or inefficient. Their low success rate and poor patient compliance call for a novel treatment procedure. One option is injecting the hypertonic solution into the leaking veins to seal them and prevent blood from leaking.
This procedure, performed by a radiologist, is called venous leak embolization, performed under fluoroscopic guidance. This approach toward repairing the venous leak and erectile dysfunction is a non-invasive method with high patient compliance.
Venous Leak Embolization
Two different approaches can perform the three-dimensional non-invasive endovascular treatment. While the antegrade approach is through accessing the deep dorsal penile vein, retrograde transfemoral venous reach the venous plexus through internal iliac veins.
Although both approaches aim to embolize the periprostatic venous plexus along with other unusually shaped or abnormally functioning veins due to valvular incompetence, antegrade endovascular treatment is preferred since it provides a more direct route for catheterization of the periprostatic venous leaks.
Fluoroscopic guidance helps the catheter reach the specific veins, after which a diagnostic venogram embolization is performed using N-butyl-2-cyanoacrylate and ethiodized oil mixed in specific ratios depending on proximity, size, and extent of venous leaks.
The entire procedure is performed under continuous fluoroscopic control in neutral projection with optional oblique projection for precision-guided embolization of incompetent pelvic veins.
3D precision-guided embolization of venous leak is a complex and challenging procedure that requires high expertise in the said field. Dr. Imtiaz Ahmed introduced its treatment in Pakistan in 2019, making him a pioneer. Dr. Imtiaz Ahmad is an endovascular surgical specialist and an interventional radiologist who treats men suffering from venous leakage, erectile dysfunction, and infertility issues. His expertise in the field speaks volumes for itself, which the accolades of his treated patients can infer.
In conclusion, erectile dysfunction and vascular disease are closely related. ED can be an early warning sign of underlying vascular disease, and men with ED need to be evaluated for underlying vascular disease.
Lifestyle changes, medications, and in some cases, surgery can help to treat both ED and underlying vascular disease. Men need to seek medical attention if they are experiencing symptoms of ED, as early detection and treatment can help to prevent serious complications.