Vasculogenic ED (Erectile Dysfunction) Program at University Hospitals
University Hospitals Harrington Heart & Vascular Institute offers a dedicated vasculogenic erectile dysfunction (ED) program in cooperation with University Hospitals Urology Institute. Through this multidisciplinary program, a team of endovascular specialists, urologists and endocrinologists provide comprehensive care for vasculogenic ED, a condition in which a man experiences the recurring inability to achieve or maintain an erection sufficient for sexual intercourse due to disease in the arteries and/or veins that supply blood to and from the penis.
Your health is important. Make an appointment today.
For men experiencing ED symptoms, the first step is an evaluation by a urologist at University Hospitals Urology Institute. If your ED is arterial, the urologist will refer you to an endovascular specialist at University Hospitals Harrington Heart & Vascular Institute.
Offering in-person, video and telephone visits. Call today to see which option is right for you 216-844-3009.
What Is Vasculogenic Erectile Dysfunction?
When a male becomes sexually aroused, the blood vessels in the penis relax and expand so that blood fills the two chambers of sponge-like erectile tissue, called the corpora cavernosa, that run the length of the organ. Blood becomes trapped under high pressure in the erectile tissue to produce an erection.
ED, also called impotence, is divided into two categories: organic and psychogenic. Psychogenic ED is psychological in origin. Organic causes of ED are subdivided into vasculogenic, neurogenic and hormonal types. Representing the most common type of ED overall, vasculogenic ED occurs when the arteries and/or veins that bring blood to and from the penis, respectively, are not functioning correctly due to blockages, narrowing or other physiological causes. Vasculogenic ED encompasses two main types:
- Arteriogenic ED, or arterial ED, occurs when atherosclerosis (buildup of cholesterol plaque in arteries) causes a blockage in one more of the arteries that supply blood to the penis.
- Venogenic ED – also called venous ED, VED, venous leak or venous leak syndrome – is when the inflow of arterial blood flow to the penis is sufficient, but outgoing blood drains too rapidly from the erectile tissue to maintain a normal erection for the duration of sexual intercourse.
What Are Vasculogenic Erectile Dysfunction Symptoms?
Symptoms of vasculogenic ED can include:
- Difficulty achieving an erection
- Difficulty maintaining an erection for the duration of sexual intercourse
- Reduced sexual desire
What Are Vasculogenic Erectile Dysfunction Causes and Risk Factors?
The primary causes and risk factors for arterial ED are health conditions that cause or contribute to the narrowing or blockage of blood vessels, including:
- Peripheral artery disease (clogged arteries in the legs or lower extremities)
- Coronary artery disease (clogged arteries in the heart)
- High blood pressure
- High cholesterol
Causes and risk factors for venous leak are similar to those for arterial ED but also include:
- Peyronie’s disease (a buildup of scar tissue in the penis that causes curved, painful erections)
- Certain neurological disorders
- Excessive anxiety or stress
How is Vasculogenic Erectile Dysfunction Diagnosed?
For men experiencing ED symptoms, University Hospitals recommends a full evaluation by a urologist at University Hospitals Urology Institute, including blood testing and ultrasound of the penis and pelvis.
If your initial examination and testing suggest your ED is likely to be arterial, the urologist will refer you to an endovascular specialist at University Hospitals Harrington Heart & Vascular Institute. The endovascular specialist will use one or more of the following imaging techniques to locate any arterial blockages that could be the cause of your ED:
- Doppler Ultrasound
This procedure uses sound waves to show how blood is flowing in and out of the penis.
- Selective Penile Angiography
In this procedure, a contrast dye is introduced into the circulatory system of the lower urinary tract via a micro-catheter before x-ray images of the penis are taken. The dye makes the blood vessels in the penis visible in x-rays, so that the doctor can see any blockages or narrowing.
- Magnetic Resonance Arteriography (MRA)
MRA is a type of magnetic resonance imaging (MRI). In this test, radio waves, a magnetic field and a computer create a scan of the blood vessels in the pelvis and penis. As part of the test, a contrast dye is introduced into the bloodstream through a micro-catheter to make the blood vessels easier to see.
- Computed Tomography Angiography (CTA)
A computerized tomography (CT) scan combines a series of cross-sectional x-ray images taken from different angles around the body. A CTA is a type of CT scan that includes the use of an injected contrast material to make, in this case, the blood vessels of the penis and pelvic region more visible in the images.
In diagnosing venous ED, the doctor may use one or both of the following tests:
- Doppler Ultrasound: This procedure uses sound waves to show how blood is flowing in and out of the penis.
- Dynamic Infusion Cavernosometry: In this test, a doctor measures pressure in the penis during an erection to determine the degree of venous leakage. Cavernosometry is usually used in men who have already had a Doppler ultrasound that indicated venous leakage.
Vasculogenic Erectile Dysfunction Treatment
Non-Invasive TreatmentsWhen appropriate, non-invasive methods are tried first in the treatment of vasculogenic impotence. These treatments include:
- Phosphodiesterase Type-5 Inhibitors (Viagra, Cialis, Levitra and Stendra) taken in pill form
- Testosterone Therapy if blood testing indicates low testosterone levels
- Intracavernosal Injection: direct injection of potency-enhancing medications such as prostaglandin E1, papaverine and phentolamine into the penis
- Intraurethral Medication/Urethral Suppository: medication administered as a small tablet that is inserted directly into the urethra; specific medications introduced this way include vasodilators (drugs that increase blood flow by expanding blood vessels) such as alprostadil
Minimally Invasive Endovascular Procedure and Other Treatments
If initial tests indicate blockage or narrowing of the arteries that carry blood into the penis, a vascular doctor may recommend a minimally invasive endovascular intervention. In this procedure, an endovascular specialist utilizes angioplasty to fix the blockages responsible for preventing sufficient blood flow to the penis.
Minimally Invasive Endovascular Procedure for Vasculogenic Erectile Dysfunction
Angioplasty is a procedure in which the endovascular specialist repairs the dissected section of an artery by inflating a special balloon inside the artery to widen it. During the procedure, the specialist may also place a stent (a mesh-like device to hold the artery open) at the site of the angioplasty to keep the artery open. In this way, the specialist eliminates the blockage in the same way that specialists fix arterial blockages in the brain, heart and elsewhere in the body. Men undergoing this minimally invasive procedure at University Hospitals Cleveland Medical Center are under conscious sedation. The procedure takes about an hour to 90 minutes.
Other vasculogenic ED treatments available through University Hospitals’ vasculogenic ED program that may be recommended after other treatments for ED have failed include the following:
- Penile Arterial Surgery: In this procedure, the surgeon transfers an artery from behind the abdominal muscle to a penile artery to create a path to the penis that bypasses the area of the blocked artery inhibiting blood flow to the penis.
- Penile Vein Ligation: In cases of positively confirmed venous leakage, the doctor may recommend surgery to close off (ligate) some of the penile veins so that the penis can better trap the amount of blood needed to maintain an erection.
- Penile Implants: Penile implants are devices surgically placed inside the penis to help men with ED obtain an erection.
The Link Between Vasculogenic Erectile Dysfunction and Cardiovascular Disease
The medical establishment has long recognized the connections between vasculogenic ED and cardiovascular disease. In fact, vasculogenic ED almost always precedes other types of atherosclerotic cardiovascular disease, including heart attack and stroke. As such, assessment and management of vasculogenic ED through a program like University Hospitals’ multidisciplinary vasculogenic ED program not only helps in successfully treating ED, but can also put the patient on a life-saving care path that can result in the identification, treatment and/or prevention of other more serious forms of cardiovascular disease.
Tony H. was in his early thirties when he began experiencing something new and negative. During sex, he would lose his erection. The more he thought about it, the more it affected him and the more it seemed to happen. He decided to seek the care of a urologist in his home state of Florida…