Arterial Leakage: An Unrecognized Cause of Erectile Dysfunction of a Vascular Origin

Abstract

Objective:

The purpose of this study is to evaluate the type of vascular impairment involved in a cohort of patients referred by an andrology specialist to the Doppler specialist to be tested for severe erectile dysfunction.

Methodology:

A descriptive cross-sectional study was carried out by recruiting patients complaining of severe erectile dysfunction (International Index of Erectile Function [IIEF] score of 5-7). Patients were evaluated by color Doppler after an intracavernous administration of prostaglandin E1 (PGE1) as a vasoactive agent. The data obtained were categorized into three groups according to the vascular mechanisms involved in the erectile dysfunction: insufficient arterial inflow, venous leakage, and arterial leakage.

Results:

An erectile dysfunction test was performed on 32 patients between 21 and 65 years of age. Nineteen patients (59.3%) were found to have arterial insufficiency. Six cases (18.7%) presented with venous leakage. Eleven cases (34%) had outflow toward the dorsal arteries of the penis from the cavernosal arteries consistent with true arterial leaks.

Conclusion:

According to the results obtained in this patient series, the main vascular factor affecting the erectile function was arterial insufficiency. Nonetheless, a new category of erectile dysfunction of vasculogenic origin should also be considered in patients with severe erectile dysfunction. It would consist of an arterial leakage via a dorsal communicating artery that runs through the tunica albuginea carrying flow away from the cavernosal artery to a dorsal artery of the penis, thus producing a true arterial leak, as opposed to the normal helicine arteries that are seen running through the tunica albuginea but only in the ventral aspect of the penis.