Endovascular Occlusion in Combined Treatment of Arteriovenous Erectile Disfunction

Abstract

BACKGROUND: The vasculogenic nature of the erectile dysfunction (ED) prevails over other causes and accounts for 70%, of which 30% is arteriogenic, 20% to 40% is venogenic, and 30% is mixed arteriovenous ED. The main importance of shock wave therapy (SWT) in the treatment of ED is a complex positive effect on the blood supply of the penis. However, there is not enough information in the literature about the use of SWT in patients with arteriovenous ED, which determines the relevance of research in this direction. AIM: To evaluate the results of combined treatment (SWT and endovascular embolization of the deep dorsal vein (DDV) of the penis) in patients with arteriovenous ED. MATERIALS AND METHODS: In the Federal State Research Center of the Federal Medical and Biomedical Agency named after AI Burnazyan of Russia 45 patients aged 26 to 45 years (35.5 ± 9.5) years with a confirmed clinical diagnosis of arteriovenous ED, who underwent combined treatment were examined. The treatment was performed in 2 stages: stage I included endovascular embolization of the dorsal penile vein; stage II consisted of SWT with the use of BTL-6000 SWT TOPLINE device (BTL Corporate) in 2 weeks after surgical treatment. The condition of patients was assessed before treatment and 1 and 12 months after it. The assessment was based on the data of the questionnaire of the International Index of Erectile Function, fifth revision (IIEF-5), and the Erection Rigidity Scale (ESR), as well as instrumental diagnostic methods: computer dynamic cavernosography and pharmacodoplerography. RESULTS: An improvement of blood flow velocity parameters, a positive dynamic according to IIEF-5 and SER in 1 year following treatment. CONCLUSIONS: The use of endovascular occlusion in combination with SWT is the correct method of treatment for arteriovenous ED, but still requires further study.