A case report of pudendal arteries angioplasty with sirolimus drug-coated balloon and drug-eluting stent associated with intracavernous autologous peripheral blood mononuclear cells injection for untreatable vasculogenic erectile dysfunction

Background Erectile dysfunction (ED) is a prevalent health problem that seriously impacts men's quality of life. The potential treatment of ED by percutaneous approach has emerged with valid angiographic results and a significant improvement in symptoms and quality of life. In addition, cell-based regenerative therapies aiming at enhancing neovascularization have been successfully performed with peripheral blood mononuclear cells (PBMNCs) in diabetic patients affected by critical limb ischaemia. Case summary We report a case of a young insulin dependent (ID) diabetic patients who suffered of severe vasculogenic erectile dysfunction associated with a poor response for more than 1 year to oral phosphodiesterase-5 inhibitors (PDE5i) and intracavernous (IC) phosphodiesterase type 1 (PDE1) therapy. At selective angiography of the pelvic district, a severe atherosclerotic disease of the internal iliac and pudendal artery was evident with absence of distal vascularization of the cavernous bodies. The patient was treated by mechanical revascularization with drug-coated balloon and drug-eluting stent placement associated with IC injection of autologous PBMNCs. Immediate and 1-year clinical and angiographic follow-up are described. Discussion Percutaneous revascularization with drug-coated balloon and drug-eluting stent associated with IC autologous PBMNCs cells injection is a safe and effective procedure to restore normal erectile function in diabetic patients affected by severe vasculogenic ED not responding to conventional oral drug therapies.

ustification of the optimal scheme of shock wave therapy for vasculogenic erectile dysfunction

Introduction. Shock wave therapy (SWT) has been used quite successfully to treat erectile dysfunction (ED). However, the question of the optimal SWT regimen for the treatment of erectile dysfunction remains unresolved and is the subject of discussion among both physicians and manufacturers of medical equipment. Purpose of the study. Develop and substantiate the most effective SWT regimen for the treatment of erectile dysfunction, based on the analysis of 28 scientific clinical studies. Metrials and methods. To solve the problem, we analyzed 28 scientific clinical studies containing data on the use of shock wave therapy in the treatment of vasculogenic ED in a clinical setting. Results. In the field of research, we developed and substantiated the SWT scheme for the treatment of vasculogenic ED. The scheme consists of a 9-week course (3 – therapy, 3 – break, 3 – therapy), contains 12 procedures (2 procedures per week); impulses are applied to 5 points, 500 impulses each (2500 per procedure); the total number of impulses per course is 30,000. Conclusions. Thus, we have proposed a differential approach to the choice SWT regimen for the treatment of vasculogenic ED. Conservative tactics involves the use of medications (primarily PDE-5). Nevertheless, SWT can and should be applied within the framework of this tactic, and the optimal scheme is established mathematically by analyzing the literature data. Within the framework of a differentiated approach, we have determined the optimal schemes for conducting shock wave therapy in the treatment of vasculogenic erectile dysfunction.

Efficacy of Aspirin for Vasculogenic Erectile Dysfunction in Men: A Meta-Analysis of Randomized Control Trials

One of the major causes of erectile dysfunction (ED) is an endothelial vascular disorder. This meta-analysis is performed to determine the efficacy of aspirin on erectile function in men with vasculogenic ED. For this purpose, CENTRAL, MEDLINE, and reference lists of articles up to November 2019 were searched. Randomized controlled trials (RCTs) were selected that compared aspirin with placebo in men of any ethnicity with vasculogenic ED. A total of 58 trials were retrieved. Finally, two trials of 214 men fulfilled our selection criteria. High selection and detection bias were identified for one trial. The participants showed a significant improvement in erectile function when they took aspirin (mean difference: 5.14, 95% CI [3.89, 6.40], and I2 = 0%). Although the present meta-analysis suggested that aspirin has a significant effect on the improvement of erectile function, there were limited RCTs available on this topic and doses of aspirin varied. Additional studies are needed to support findings from this meta-analysis. Aspirin needs to be considered by practitioners when prescribing drugs for vasculogenic ED.