Erectile dysfunction: what to do if even medication no longer works?

Catheter treatment can often correct erectile dysfunction

Erectile dysfunction is a relatively common complaint, but most people are reluctant to talk about it. So the problems often go untreated or people try to help themselves with tablets. In many cases, however, the disease is based on an atherosclerotic circulatory disorder in which arteries of the pelvis and penis are narrowed or closed so that an erection can no longer be achieved, reports the German Society for Angiology - Society for Vascular Medicine (DGA). A catheter treatment with or without stent implantation could help here.

According to the German Society for Angiology, more than half of all men with erectile dysfunction do not respond adequately to medication or suffer from side effects. Professor Dr. explains what opportunities there are to help these men too. Nikolas Diehm, founder and medical director of the Center for Vascular Medicine Mittelland (Aarau, Switzerland) in a press release on the occasion of the 2nd intervention congress of the German Society for Angiology (DGA).

Catheter therapy with or without a stent

According to the expert, catheter treatment with or without stent implantation remains a promising option if the erectile dysfunction is due to atherosclerotic circulatory disorder and medication has no effect. Diehm reports that catheter therapy is a fascinating opportunity to improve the “penis claudication” in a minimally invasive manner, regarding the angiological treatment options for erectile dysfunction.

Minimally invasive intervention

As early as 1923, according to the DGA, the influence of pelvic artery occlusions on erectile ability was first described by vascular surgeon René Leriche. "It has long been known that revascularization in this area, be it surgical or endovascular, can improve erectile function." But the surgical options were limited for a long time. Only a few years ago, thanks to improved diagnostics and minimally invasive technology, vascular physicians have also ventured into finer, lower-lying arteries that are relevant for erection, according to the DGA. The intervention extends right into the penis and the blood vessels are sometimes less than a millimeter in diameter, reports the specialist society.

Arteries are dilated and stabilized

In the methods used today, the arteries are either dilated only with a balloon or, if necessary, additionally stabilized with a stent. According to the DGA, drug-coated balloons and stents are also used. The intervention had proven to be relatively successful in the first small studies with 30 (ZEN study 2012) and 25 patients (PERFECT I study 2014). About 60 percent of the men treated had improved erectile function and the result was confirmed by the subsequent PERFECT II-IV studies and the PERFECT registry. According to the DGA, the procedure was safe for all patients.

What jeopardizes the success of treatment?

According to the experts, limiting factors for the success of treatment are, for example, advanced pre-damage to the smallest blood vessels (microangiopathy) and nerve pathways (peripheral neuropathy) due to diabetes or prostate diseases. Cigarette, alcohol and drug use can also have a negative impact. The basic principle was: "The more reliably the functional disorder is largely attributable to the narrowed arteries, the more likely the treatment success." Younger patients respond particularly well to catheter therapy, while the chances of success decrease with increasing age.

Erectile dysfunction is a warning sign

According to the DGA, erectile dysfunction is often the first indication of other manifestations of atherosclerosis, such as coronary artery disease (CHD), peripheral arterial disease (PAD) or narrowed carotid artery (carotid stenosis). If there are any problems, a medical check should be carried out urgently. After the diagnosis has been made, this trace must also be followed in order to prevent a heart attack or stroke, emphasizes Dr. Hans Krankenberg, head of the angiology department at the Asklepios Clinic Harburg, in the DGA press release.

Further research needs

According to the experts, there is still some need for research into the possibilities of catheter therapy because, for example, the risk of renewed artery occlusion after the procedure is significantly greater than that of coronary arteries of comparable caliber. The so-called restenosis rate is after all almost 40 percent after six months. So far, the reason for this is not known. However, even with restenosis, there is often no renewed impairment of the erectile function of the patient.

Consider other causes of erectile dysfunction

Basically, it should be borne in mind that erectile dysfunction can have a variety of other causes besides atherosclerosis. Here, for example, testosterone deficiency, neurological diseases or psychological stress can be mentioned as possible triggers. The experts also explain that common drugs such as beta blockers and antidepressants often impair sexual function. So before considering surgery, the various possible causes of the problems should be checked. (fp)

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Video: Erectile dysfunction and physical therapy. Connect PT (May 2021).