Endovascular and two-stage combined revascularization of the penis at arteriogenic erectile dysfunction

The possibility of application of endovascular and two-stage combined revascularization of the penis in the arteriogenic ED treatment is shown. Twenty male patients with multifocal atherosclerotic lesions of the aorto-iliac-femoral segments underwent the analysis of the branching patterns of the IPA according to the classifcation by Adachi and Yamaki followed by the interventional endovascular intervention (angioplasty, stenting) of the iliac arteries. Seventeen patients underwent the unilateral and three patients – bilateral stenting of the common and external iliac arteries. Three patients out of the total number of the operated ones additionally underwent an open revascularization of the penis by epigastric-penic anastomosis. A complex preoperative examination of patients – candidates for revascularization of the penis for arteriogenic erectile dysfunction was performed and included ultrasound, МCT-angiography of the pelvic arteries, and electroneuromyographic examination of atherosclerotic lesions of the pool vessels of the inner pudental artery. Subsequently, endovascular and combined open revascularization operations were performed on the iliac and penis vessels. The erectile function improvement according to the IIEF-5 scale (8–12 scores before the operation vs 16–19 points after the operation) was noted in 1, 3, 6, 12 months (p < 0.05). Combined revascularization operations on the iliac and penis arteries (endovascular and open “bypass”) allow an adequate arterial blood perfusion to the penis in the steno-occlusive lesions of the pool vessels of the IPA affected by atherosclerosis.

1. Nieschlag E., Behre H. M. (eds.). Andrology: male reproductive health and disfunction. 2nd ed. Berlin, Heidelberg, 2001. 551 p. (Russ. ed.: Andrologiya: muzhskoe zdorov’e i disfunktsiya reproduktivnoi sistemy. Moscow, Medical Information Agency Publ., 2005. 551 p.).

2. Gregoire A., Pryor J. P. (eds.). Impotence: An Integrated Approach to Clinical Practice. New York, Churchill Livingstone. 231 p. (Russ. ed.: Impotentsiya: integrirovannyi podkhod k klinicheskoi praktike. Moscow, Meditsina Publ., 2000. 236 p.).

3. Male Sexual Dysfunction. European Association of Urology. Available at: http:// http://uroweb.org/guideline/malesexual-dysfunction/#3 (accessed 15.01.2018).

4. Moncada I. Complications of Surgery for Erectile Dysfunction ESU organized Course Management of surgical complications in urology. XIII s’ezd i XVII kongress Rossiiskogo obshchestva urologov, 110 let Rossiiskomu obshchestvu urologov (Moskva, 08–10 noyabrya 2017 goda): materialy kongressa [XIII Congress and XVII Congress of the Russian Society of Urology, 110 years to the Russian Society of Urology (Moscow, November 08–10, 2017): Congress materials]. Moscow, pр. 34–41.

5. Zhukov O. B., Shcherbinin C. H., Ukolov V. A. X-ray endovascular methods of treatment of vasculogenic erectile dysfunction. Andrologiya i genital’naya khirurgiya = Andrology and Genital Surgery, 2014, vol. 15, no. 3, pp. 67–73 (in Russian).

6. Povelitsa E. A., Dosta N. I., Bystrenkov A. V., Domantsevich V. A., Nitkin D. M., Shesternya A. M., Sosnovskaya A. S. Dynamic multispiral computer contrast angiography of an internal pudendal artery – an innovative diagnostic method of arteriogenny erectile dysfunction. Innovatsionnye tekhnologii v meditsine [Innovative technologies in medicine], 2017, no. 3, pp. 155–166 (in Russian).

7. Kawanishi Y., Lee K. S., Kimura K., Kojima K., Yamamoto A., Numata A. Feasibility of multi-slice computed tomography in the diagnosis of arteriogenic erectile dysfunction. BJU International, 2001, vol. 88, no. 4, pp. 390–395. https://doi.org/10.1046/j.1464-410x.2001.02316.x

8. Povelitsa E. A., Dosta N. I., Domantsevich V. A., Grakhovskii S. Yu., Filyustin A. E., Anichkin V. V., Nitkin D. M., Shesternya A. M. Modern diagnostic methods of a vascular form of erectile dysfunction. Meditsina [Medicine], 2016, no. 1, pp. 34–40 (in Russian)

9. Pereira J. A., Bilhim T., Rio Tinto H., Fernandes L., Martins P. J., Goyri-O’Neill J. Radiologic anatomy of arteriogenic erectile dysfunction. Acta Médica Portuguesa, 2013, vol. 26, no. 3, pp. 219–225.

10. Povelitsa E. A., Dosta N. I., Parkhomenko O. V., Nitkin D. M., Shesternya A. M., Anichkin V. V. Ultrasound examination of an internal sexual artery transperineal access at arteriogenny erectile dysfunction. Urologiya [Urology], 2017, no. 4, pp. 55–61 (in Russian).

11. Kyzlasov P. S., Abdulkhamidov A. N. Penis revascularization – modern approach. Eksperimental’naya i klinicheskaya urologiya [Experimental and clinical urology], 2014, no. 3, pp. 66–68 (in Russian).

12. Kyzlasov P. S., Abdulkhamidov A. N., Sergeev V., Bokov A. I., Volodin D. I., Zabelin M. V. Penis revascularization with use of a laparoscopic technique of a harvesting of the lower epigastric artery. Urologiya [Urology], 2017, no. 3, pp. 84–85 (in Russian).

13. Rogers J. H., Goldstein I., Kandzari D. E., Köhler T. S., Stinis C. T., Wagner P. J., Popma J. J., Jaff M. R., RochaSingh K. J. Zotarolimus-eluting peripheral stents for the treatment of erectile dysfunction in subjects with suboptimal response to phosphodiesterase-5 inhibitors. Journal of the American College of Cardiology, 2012, vol. 60, no. 25, pp. 2618–2627. https://doi.org/10.1016/j.jacc.2012.08.1016

14. Kim E. D., Owen R. C., White G. S., Elkelany O. O., Rahnema C. D. Endovascular treatment of vasculogenic erectile dysfunction. Asian Journal of Andrology, 2015, vol. 17, no. 1, pp. 40–43. https://doi.org/10.4103/1008-682x.143752

15. Adachi B., Hasebe K., Daigaku K. Das Arterien System der Japaner. Bd. 1. Kyoto, Kaiserlich-Japanischen Universität zu Kyoto, 1928. 440 S. (in German).

16. Yamaki K.-I., Saga T., Doi Y., Aida K., Yoshizuka M. A statistical study of the branching of the human internal iliac artery. Kurume Medical Journal, 1998, vol. 45, no. 4, pp. 333–340. https://doi.org/10.2739/kurumemedj.45.333

17. Bystrenkov A., Povelitsa E., Serdyuchenko N., Dosta N., Nitkin D. Clinical assessment of options of branching of an internal ileal artery when carrying out radiological methods of a research at patients with a multifocal atherosclerosis. Vestsi Natsyyanal’nai akademii navuk Belarusi. Seryya medytsynskikh navuk = Proceedings of the National Academy of Sciences of Belarus. Medical series, 2017, no. 2, pp. 41–49 (in Russian).

18. Tubbs R. S., Shoja M. M., Loukas M. Bergman’s comprehensive encyclopedia of human anatomic variation. New Jersey, John Wiley & Sons, 2016. 1456 p.

19. Kawanishi Y., Muguruma H., Sugiyama H., Kagawa J., Tanimoto S., Yamanaka M., Kojima K., Numata A., Kishimoto T., Nakanishi R., Kanayama H. Variations of the internal pudendal artery as a congenital contributing factor to age at onset of erectile dysfunction in Japanese. BJU International, 2008, vol. 101, no. 5, pp. 581–587. https://doiorg/10.1111/j.1464-410x.2007.07284.x