Erectile Dysfunction What to do if even medicines do not work anymore?

Catheter treatment can often repair 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 man tries to help with pills. In many cases, however, the disease is due to an atherosclerotic circulatory disorder in which arteries of the pelvis and penis are narrowed or occluded so that 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 can remedy this situation.

According to the German Society of Angiology, more than half of all men with erectile dysfunction do not respond adequately to medication or suffer from side effects. What possibilities exist for helping these men? 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 of Angiology (DGA).

Many men suffer from erectile dysfunction in which tablets can not help. Here, according to experts, catheter treatment offers a promising option. (Image: dmitrimaruta / fotolia.com)

Catheter therapy with or without stent

If the erectile dysfunction is due to an atherosclerotic circulatory disturbance and medications have no effect, catheter treatment with or without stent implantation remains a promising option, according to the expert. Catheter therapy provides a fascinating opportunity to improve "penile claudication" in a minimally invasive manner, Diehm reports on the angiological treatment options for erectile dysfunction.

Minimally invasive procedure

Already in 1923, according to the DGA for the first time by the vascular surgeon René Leriche the influence of pelvic artery occlusions on the erectile ability was described. For example, "it has long been known that revascularization in this area, be it surgical or endovascular, can improve erectile function." However, surgical options have been limited for a long time. For only a few years now, thanks to improved diagnostics and minimally invasive techniques, vascular physicians have also ventured to finer, lower-lying arteries that are relevant for erection, according to the DGA. The procedure extends into the penis and some of the blood vessels have a diameter of less than one millimeter, reports the association.

Arteries are widened and stabilized

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

What endangers the treatment success?

Restrictive factors for the success of treatment are, according to the experts, for example, advanced pre-damage of the smallest blood vessels (microangiopathy) and neural pathways (peripheral neuropathy) by diabetes or prostate disease. Cigarette, alcohol and drug use can also have a negative impact. The basic principles are: "The safer the dysfunction is primarily due to the narrowed arteries, the more likely the treatment success." Younger patients respond particularly well to the catheter therapy, while with increasing age, the chances of success decline.

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 heart disease (CHD), peripheral arterial disease (PAD) or narrow carotid arteries (carotid artery stenosis). So should a medical examination urgently take place with appropriate problems. After the diagnosis, this track must also be pursued in order to prevent a heart attack or stroke. Hans Krankenberg, Head of the Department of Angiology of the Vascular Center in the Asklepios Klinikum Harburg, in the press release of the DGA.

Further research needs

According to the experts, there is still a need for research on the possibilities of catheter therapy, since, for example, the risk of a renewed arterial occlusion after the procedure is significantly greater than with coronary vessels of comparable caliber. After all, the so-called restenosis rate is almost 40 percent after six months. So far, the reason for this was not known. However, even in restenosis, there is often no renewed impairment of the erectile function of the patients.

Consider other causes of erectile dysfunction

Basically, it should be considered that erectile dysfunction in addition to atherosclerosis may have many other causes. Here, for example, testosterone deficiency, neurological disorders or mental stress as possible triggers. Even with common drugs such as beta-blockers and antidepressants, the sexual function is often impaired, explain the experts. So before considering an operation, first of all the different possible causes of the problems should be checked. (Fp)