Erectile dysfunction – new cause, new treatment strategy

In a Deep Dive session, Doctor Nikolaos Ioakeimidis and colleagues from the National & Kapodistrian University of Athens (Greece) described their study on the association between antihypertensive medication use, blood pressure (BP) and ED.

Penile Doppler ultrasonography was used to measure peak systolic velocity (PSV) in 356 consecutive men with ED without a history of diabetes and CVD. The cohort was divided into three categories according to office systolic BP (SBP) and diastolic BP (DBP): normal (SBP<130 and DBP<85 mmHg, n=117), high-normal (130≤SBP<140 or 85≤DBP<90 mmHg, n=91) and hypertension (SBP≥140 or DBP≥90 mmHg, n=148). In total, 164 (46%) patients were treated with antihypertensives.

Low PSV values after intracavernous injection of prostaglandin E1 indicate impaired penile blood inflow and severe vasculogenic ED. Among males not receiving antihypertensive medications, there was a progressive decrease in PSV values from normal BP, to high-normal BP and to hypertension (p=0.01 after adjustment for age). In contrast, among males on antihypertensives, all three BP categories had similarly low PSV levels (p=0.54 after adjustment for age). These findings may reflect an undesirable action of antihypertensives, and further studies are needed to understand the effects of different antihypertensive medication classes.

Professor Tzung-Dau Wang and a team from the National Taiwan University Hospital (Taipei City, Taiwan) investigated a new treatment for ED with concomitant internal pudendal artery stenoses. Obstructive pelvic arterial lesions are common in older men who have ED, with ~40% of pelvic obstructive lesions being located in the internal pudendal artery. However, previous attempts to open the internal pudendal artery with drug-eluting stents resulted in binary restenosis in around 40–50% of cases.

As described in their ePoster, Wang et al conducted the proof­-of­-concept, single-arm PERFECT-ABSORB study to assess the feasibility and safety of bioresorbable everolimus­-eluting vascular scaffolds (BVS), facilitated by intravascular optical coherence tomography (OCT), in patients with ED and concomitant internal pudendal artery stenoses.

Patients were recruited with ED and obstructive lesions (unilateral diameter stenosis ≥70% or bilateral stenoses ≥50%) in the internal pudendal arteries with reference vessel diameter ≥2.5 mm and ≤4.0 mm and a target lesion length ≤30 mm in the pelvic computed tomographic (CT) angiography. All subjects underwent pelvic CT angiography, penile Doppler ultrasonography and invasive pelvic angiography with OCT at baseline and after 8 months.

In total, 31 BVSs were implanted into 18 patients who had median duration of ED of 3 years: 7 patients were treated with 1 BVS, 9 patients with 2 BVSs and 2 patients with 3 BVSs. Among the 17 patients available for 8-month follow-­up, the primary endpoint of binary CT angiographic restenosis (≥50% lumen diameter stenosis) developed in 7 (37%) of 19 lesions and 7 (41%) of 17 patients. After excluding those with lesions >30 mm (per-protocol analysis), binary CT angiographic restenosis developed in 5 (31%) of 16 lesions and 5 (36%) of 14 patients. Sustained clinical success in erectile function was achieved by 9 patients (53%) after 12 months.

The authors concluded that the BVS–OCT strategy was safe and was associated with a numerically lower restenosis rate than seen previously, achieving 30% restenosis rate in lesions ≤30 mm in length. Other intervention strategies to mitigate the restenosis rate are currently being tested.