Sai K Doppalapudi1, Ethan Wajswol1, Pratik A Shukla2, Marcin K Kolber3, Manu K Singh4, Abhishek Kumar5, Aaron Fischman6, Ardeshir R Rastinehad7. 1. Division of Focal Therapy and Interventional Urologic Oncology, Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 625 Madison Avenue, New York, NY 10022; Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey. 2. Division of Vascular and Interventional Radiology, Department of Radiology, Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 625 Madison Avenue, New York, NY 10022; Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey. 3. Division of Vascular and Interventional Radiology, Department of Radiology, Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 625 Madison Avenue, New York, NY 10022; Division of Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, Texas. 4. Division of Vascular and Interventional Radiology, Department of Radiology, Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 625 Madison Avenue, New York, NY 10022; Division of Vascular and Interventional Radiology, Department of Radiology, Santa Barbara Cottage Hospital, Santa Barbara, California. 5. Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey. 6. Division of Vascular and Interventional Radiology, Department of Radiology, Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 625 Madison Avenue, New York, NY 10022. 7. Division of Vascular and Interventional Radiology, Department of Radiology, Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 625 Madison Avenue, New York, NY 10022; Division of Focal Therapy and Interventional Urologic Oncology, Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, 625 Madison Avenue, New York, NY 10022. Electronic address: art.rastinehad@mountsinai.org.
Abstract
PURPOSE: To systematically review and perform a meta-analysis on the safety and efficacy of endovascular therapy in the treatment of the two most common etiologies of vasculogenic erectile dysfunction (ED): veno-occlusive dysfunction (VOD) and arterial insufficiency (AI). MATERIALS AND METHODS: PubMed, Web of Science, ScienceDirect, and Scopus databases were searched for published English literature regarding endovascular ED treatments. Case series (n ≥ 3) were included. Multiple data points were obtained, including demographic data, etiology, diagnosis method, imaging studies, treatment approach, technical success, clinical success, complications, and follow-up. RESULTS: Sixteen relevant articles were obtained and a total of 212 patients with VOD and 162 with AI were identified. The VOD cohort were treated either percutaneously (60.4%; n = 128) or after surgical exposure of the deep dorsal vein (33.5%, n = 71), or it was unspecified (6.1%; n = 13). The most common embolic used was n-butyl cyanoacrylate (51.9%; n = 109). Meta-analysis found an overall clinical success rate of 59.8% in VOD patients. Complications occurred in 5.2% of patients (n = 11), with 9 considered to be mild and 2 considered to be severe. The AI cohort contained 162 patients most commonly treated via stenting of the internal pudendal artery (40.1%; n = 65). Meta-analysis found an overall clinical success rate of 63.2% in AI patients. Complications occurred in 4.9% of patients (n = 8), with 4 considered to be mild and 4 considered to be severe. CONCLUSIONS: Endovascular therapy for medically refractory ED is safe and may provide a treatment alternative to more invasive surgical management; however, conclusions are limited by the heterogeneity of clinical success definitions among the included studies.
PURPOSE: To systematically review and perform a meta-analysis on the safety and efficacy of endovascular therapy in the treatment of the two most common etiologies of vasculogenic erectile dysfunction (ED): veno-occlusive dysfunction (VOD) and arterial insufficiency (AI). MATERIALS AND METHODS: PubMed, Web of Science, ScienceDirect, and Scopus databases were searched for published English literature regarding endovascular ED treatments. Case series (n ≥ 3) were included. Multiple data points were obtained, including demographic data, etiology, diagnosis method, imaging studies, treatment approach, technical success, clinical success, complications, and follow-up. RESULTS: Sixteen relevant articles were obtained and a total of 212 patients with VOD and 162 with AI were identified. The VOD cohort were treated either percutaneously (60.4%; n = 128) or after surgical exposure of the deep dorsal vein (33.5%, n = 71), or it was unspecified (6.1%; n = 13). The most common embolic used was n-butyl cyanoacrylate (51.9%; n = 109). Meta-analysis found an overall clinical success rate of 59.8% in VOD patients. Complications occurred in 5.2% of patients (n = 11), with 9 considered to be mild and 2 considered to be severe. The AI cohort contained 162 patients most commonly treated via stenting of the internal pudendal artery (40.1%; n = 65). Meta-analysis found an overall clinical success rate of 63.2% in AI patients. Complications occurred in 4.9% of patients (n = 8), with 4 considered to be mild and 4 considered to be severe. CONCLUSIONS: Endovascular therapy for medically refractory ED is safe and may provide a treatment alternative to more invasive surgical management; however, conclusions are limited by the heterogeneity of clinical success definitions among the included studies.
Authors: Sandro La Vignera; Andrea Crafa; Rosita A Condorelli; Federica Barbagallo; Laura M Mongioì; Rossella Cannarella; Michele Compagnone; Antonio Aversa; Aldo E Calogero Journal: Andrology Date: 2021-05-06 Impact factor: 3.842