Erectile dysfunction, which is the inability to get and keep an erection strong enough for sexual activity, is a common condition among men. Up to 43.5% of men in their sixties may suffer from erectile dysfunction.
Blood must remain in the penis until ejaculation in order for a man to maintain a rigid erection during sexual activity. Vein constriction, or veno-occlusion, happens to keep blood inside, and the man’s veins will widen upon climax, returning blood to the body.
The erection will end if the veins do not tighten sufficiently, allowing blood to leak back into the body. Many men who suffer from this kind of erectile dysfunction discover that while they can initially achieve a solid erection, they are unable to maintain rigidity. Venous leak is the primary cause of erectile dysfunction, presented in over 80% of cases in Singapore
Inability to sustain an erection for sexual intercourse.
There are several factors which may exacerbate the risk of erectile dysfunction, and these include:
- High blood pressure
- High cholesterol
- Diabetes
- Peripheral vascular disease
- Excessive stress
- Obesity
- Family history of atherosclerosis
- Smoking
- Anxiety
Doppler ultrasound is performed to examine blood flow in and out of the penis.
Cavernosography is performed to visualise venous leakage using radiographic contrast.
Non-surgical options such as medication or pump devices are often offered as treatments for erectile dysfunction. However, they do not usually fix the underlying problem, and are merely used as a temporary solution.
VIC offers a surgical option known as endovascular (retrograde/anterograde) embolisation. This procedure is performed under light sedation, and often, patients can enjoy same-day discharge and a quick return to daily activities. There is minimal pain and discomfort, and no surgical scar.
This procedure is recommended for patients diagnosed with venous leak who want to avoid invasive surgery. It involves the embolisation of the periprostatic venous plexus via the insertion of a thin catheter into the deep dorsal vein or femoral vein. X-ray fluoroscopy is used to guide the catheter towards the affected vein, and an injection of small titanium coils and embolic agents will seal off the affected vein(s) permanently.
Case Study 1
Patient presented with pelvic pain/ penile pain as well as erectile dysfunction.
Pelvic angiogram showed a stenosis of the right internal pudendal artery that was treated with angioplasty and stenting.
Fig 1: Right internal pudendal artery flow (native on left) and post angioplasty and stenting (on right) showing much improved flow.
Venous leak was also treated by glue embolisation of the peri-prostatitis veins.
Fig 2: Glue embolisation of veins
Full erectile dysfunction returned in 24 hours. Pain is also resolved.
Case Study 2
Patient presented with venous leak erectile dysfunction.
Pelvic angiogram was done to check on arterial inflow supply to the penile arteries (normal flow in this case). Venous leak was then treated with glue embolisation of the peri-prostatitis leaking vein.
Good erectile function return in 24-48 hours post.
