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Digital angiography of erectile failure
R Nessi1, L De Flaviis, G Bellinzoni
1Department of Radiology, University of Milan, Italy.
Insights
Digital angiography effectively diagnoses vascular erectile dysfunction, with intravenous contrast offering a quicker, less invasive, and equally effective alternative to arterial catheterization. This method aids in identifying penile artery steno-occlusive lesions.
Area of Science:
- Vascular Surgery
- Radiology
- Urology
Background:
- Erectile failure often stems from vascular issues.
- Accurate diagnosis of penile artery disease is crucial for effective treatment.
Purpose of the Study:
- To evaluate digital angiography for diagnosing vascular erectile dysfunction.
- To compare intravenous and intra-arterial contrast administration methods.
- To correlate angiographic findings with functional tests.
Main Methods:
- Digital angiography of pudendal and penile arteries in 44 patients.
- Comparison of intravenous (IV) and selective intra-arterial (IA) contrast injection.
- Functional assessment using nocturnal penile tumescence (NPT) and Doppler ultrasonography (DUS).
Main Results:
- 73% of patients showed penile artery steno-occlusive lesions.
- IV digital angiography yielded results comparable to IA catheterization.
- IV angiography was faster and less invasive, visualizing both arterial networks simultaneously.
- NPT results correlated well with angiographic findings; DUS was less sensitive.
Conclusions:
- Digital angiography is a valuable tool for diagnosing vascular erectile dysfunction.
- Intravenous digital angiography is a safe, efficient, and effective alternative to selective arterial catheterization.
- Angiographic findings align with NPT, supporting its role in assessing vascular erectile dysfunction severity.
Abstract:
Digital angiography of pudendal and penile arteries was performed in 44 consecutive patients with erectile failure of suspected vascular origin. Intra-arterial injection of contrast medium via selective catheterisation of the hypogastric arteries was used in six cases. In 39 patients, one of whom had already had arterial catheterisation, contrast medium was administered by the intravenous route, using a single, large volume, high speed bolus. In 12/44 cases (27%), digital angiography showed a normal vascular picture at the pudendal and penile level but the remaining 32 patients (73%) had steno-occlusive lesions of different degrees of severity. The pictures obtained after administration of intravenous contrast were diagnostically as good as the studies with selective arterial catheterisation. In addition, the intravenous route allowed the simultaneous representation of the arterial network on both sides and was quicker and less invasive. In 31/44 patients (79%), functional determinations of nocturnal penile tumescence and of penile blood flow with Doppler ultrasonography were performed for comparison. Nocturnal penile tumescence results correlated well with the angiographic picture. Penile blood flow measurements with the Doppler technique were less sensitive than digital angiography.