Can blood-flow damage behind erectile dysfunction be reversed?
In a small group of young men whose erectile dysfunction follows pelvic or perineal trauma, surgery to restore arterial blood flow has a 60% to 70% long-term success rate. For most men, blood vessel damage is not repaired directly, and treatment focuses on risk factors, PDE5 inhibitor tablets and other options. Surgery on the penile veins is not recommended.
Who can have surgery to restore blood flow to the penis?
Surgery to restore arterial blood flow, called penile revascularisation, has a 60% to 70% long-term success rate in young men with pelvic or perineal trauma. The narrowed artery must be confirmed with an X-ray of the penile arteries, and a leak in the veins of the penis rules the operation out.
The American guideline gives a conditional recommendation for this surgery only in young men with a focal blockage and no widespread vascular disease. It limits the operation to highly skilled surgeons in a centre of excellence, and men and their partners are told that its long-term success is not well established.
Why is surgery on the penile veins not recommended?
Venous ligation surgery aims to stop blood leaking out of the penis through the veins. It is not recommended because there is no compelling evidence that it is an effective treatment for most men. The European guideline no longer recommends it because of poor long-term results, and the American guideline also advises against it.
"Overall, these data indicate that penile venous ligation surgery is unlikely to result in long-term successful management of ED for the overwhelming majority of men and delays treatment with other more reliable options such as penile prosthesis surgery." Source 2, p. 34
Across studies of about 3,000 men, high early response rates generally declined rapidly over time. Even in men who seemed ideal candidates, complete response rates ranged from 11.4% to 84.0%, which calls the value of the operation into question.
How is blood-flow related erectile dysfunction usually treated?
Good control of diabetes, high blood pressure and similar conditions comes first in any treatment for erectile dysfunction. Physical activity, weight loss and treatment of heart risk factors may improve sexual function, and statins have been shown to improve erectile function in meta-analyses.
PDE5 inhibitor tablets are the first-line medicine and improve erectile function significantly with a good safety profile. Injections into the penis are an alternative first-line or second-line option, and vacuum devices suit men who want treatment without medicines.
Can shockwave therapy help blood-flow erectile dysfunction?
The two guidelines differ on low-intensity shockwave therapy. The European guideline gives a weak recommendation for it in men with mild erectile dysfunction caused by blood vessel problems and in men with this type who respond poorly to PDE5 inhibitors, where it can produce a mild improvement. It is also listed as an alternative for men who do not want, or cannot take, tablets.
The American guideline considers shockwave therapy investigational. A weak recommendation means the evidence is limited, so it is offered as an option rather than as a proven treatment.
What if other treatments do not work?
Injections into the penis are effective in more than 70% of men. A penile implant is recommended when other treatments fail or when the patient prefers it, and its satisfaction rate is among the highest of any treatment, at 92% to 100% in patients and 91% to 95% in partners.
Because erectile dysfunction caused by blood vessel problems is a risk marker for heart and blood vessel disease, the assessment also checks heart risk factors with blood tests for glucose and blood fats and a ten-year risk calculation.