Presentation Authors: Filippo Migliorini, Anna Marcer*, Marco Sebben, Silvia Bassi, Arianna Mariotto, Emanuele Rubilotta, Matteo Balzarro, Flavio Ribichini, Walter Artibani, Verona, Italy
Introduction: To assess the feasibility and efficacy of percutaneous angioplasty of Internal Pudendal Arteries (IPA) stenosis with drug-eluting paclitaxel-medicated balloons in the treatment of Erectile Dysfunction (ED) no longer responding to pharmacotherapy.
Methods: Six patients with severe ED no longer responsive to oral and intracavernosal pharmacotherapy were treated. The mean age was 61+/-5 years old. Serum testosterone and prolactin levels were normal in all patients, IIEF-5 ranged between 3 and 7 (mean 4.8). The penile dynamic Colour Duplex Doppler Ultrasound (D-CDDU) detected arteriogenic ED with Systolic Peak Velocity (PSV) between 18 and 25 cm/sec (mean 21.8). Penile rigidity was grade 1 on 4 according to Erection Hardness Score. Through a single or bilateral femoral percutaneous access, patients underwent selective angiography of internal iliac arteries and IPA. Angiographically significant stenosis of IPA (diameter obstruction >50%) were observed bilaterally in five patients and unilaterally in one. Stenosis were gradually dilated with 2.0/2.5x30/80 mm diameter medicated balloons. All patients were discharged one or two days after angioplasty on double antiplatelet therapy (clopidogrel 75 mg + ASA 100 mg) and atorvastatin 40 mg die.
Results: All procedures were successful in restoring of good IPA flow. No complications occurred. Patients were followed at 4 and 8 months. At the first check all patient reported a significant improvement in erections with an average increase of 9 points in the IIEF-5. Three patients had to use sildenafil 100 mg and three 50 mg to have good erections. D-CDDU detected an average increase of 13,5 cm/sec in PSV. At eight months, one patient was regressed at the initial state and underwent prosthesis placement; two patients had to use alprostadil 10 ugr and three had satisfactory erections using Sildenafil 100 mg.
Conclusions: IPA stenosis angioplasty with paclitaxel-eluting balloons seems to be a promising therapy for ED not responsive to pharmacotherapy. It is a safe and repeatable procedure, leads to improvement of erectile function in a good percentage of cases and should be considered as a last therapeutic opportunity before proposing a penile prosthesis.