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Are you struggling with erectile dysfunction? Join IndiaLive 2020 and learn from Prof. Sangiorgi how to treat vasculogenic erectile dysfunction.

Vasculogenic Erectile Dysfunction | Case by Prof. Sangiorgi | IndiaLive 2020 | MagicTouch ED

Vasculogenic erectile dysfunction (VED) is a type of erectile dysfunction that occurs when blood flow to the penis is reduced. VED can be caused by conditions such as atherosclerosis (hardening of the arteries), diabetes, and hypertension (high blood pressure). Treatment for VED typically includes lifestyle changes, such as quitting smoking and losing weight, and medications such as phosphodiesterase type 5 inhibitors (such as sildenafil) and testosterone replacement therapy.

Causes of Vasculogenic Erectile Dysfunction

The most common cause of vasculogenic erectile dysfunction is atherosclerosis, or hardening of the arteries. Atherosclerosis occurs when plaque builds up in the arteries, narrowing them and reducing blood flow. Other causes of VED include:

  • Diabetes
  • Hypertension (high blood pressure)
  • Obesity
  • Metabolic syndrome
  • Sleep apnea
  • Smoking
  • Alcoholism
  • Drug abuse
  • Pelvic surgery
  • Prostate cancer

Symptoms of Vasculogenic Erectile Dysfunction

The most common symptom of vasculogenic erectile dysfunction is the inability to get or maintain an erection. Other symptoms may include:

  • Reduced sex drive
  • Difficulty achieving orgasm
  • Performance anxiety
  • Relationship problems

Diagnosis of Vasculogenic Erectile Dysfunction

Your doctor will start by taking a medical history and doing a physical examination. They may also order blood tests to check for conditions that can cause VED, such as diabetes, hypertension, and low testosterone. If the cause of your VED is not clear from these tests, your doctor may order additional tests, such as:

  • Doppler ultrasound – This test uses sound waves to assess blood flow to the penis.
  • Penile angiography – This test involves injecting dye into the arteries of the penis and taking X-rays to see if the dye is flowing freely.
  • Cavernosometry and cavernosography – These tests are used to assess blood flow and the anatomy of the arteries and veins in the penis.
  • Nocturnal penile tumescence (NPT) – This test involves wearing a monitor overnight that measures erections during sleep.

Treatment of Vasculogenic Erectile Dysfunction

Treatment for VED typically includes lifestyle changes and medications. Lifestyle changes that can help improve VED include:

  • Quitting smoking
  • Losing weight
  • Exercising regularly
  • Eating a healthy diet
  • Reducing stress
  • Limiting alcohol intake

Medications that can be used to treat VED include:

  • Phosphodiesterase type
#ErectileDysfunction #IndiaLive2020 #MagicTouchED

Erectile dysfunction (ED) is defined as the recurrent inability to achieve and maintain an erection satisfactory for sexual intercourse.

ED is an important and growing health problem. lt is estimated that more than 200 million men (between 40 – 70 years) suffer from EDFollow Us on Social Media



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Video transcription:

We have a liquid from the deli now hello good morning. India live from

navara Italy and we are here to show you a case of erectile dysfunction that we currently treat in our Hospital. Almost every day with me, there is a doctor. Ricardo yo-yo is a friend and a

co-worker, and here in Italy it’s Sunday morning and so I really wish to thanks

all the cath lab staff and nurses that I’ve been so patient to come on Sunday to work with you guys and India

lights. Okay, we can start the slides. We will show you the clinical eastery Guido

thanks a lot. Ok, prossima yeah I mean in India. We thought we can

we can joke about this type of pathology, but you have to keep in mind that you

know more than 3 Millions in Italy and 300 millions in world are

affected by this pathology we do Prasanna. This is a younger man, as you can see, with no cardiovascular risk

factors, except for smoking, but he withdraw smoking. Approximately 15 years

ago. He had only positive clinical history for a Asaf anatomy that was done

in the left leg in 2016 and he started to complain about erectile dysfunction

four years ago. Of course, as a natural history of this disease

the patients usually start to have some problems. He goes to our ologist and then

the. Er ology send the patient to cardiologists to see if they can give

pde5 inhibitors to improve the erectile dysfunction symptoms. Having saying that

he was seen by a neurologist, if I can have the slide back three times and then referred to me, the urologist perform as

usual dynamic Doppler. Can we have this the other side Guido? Next, you see the

patient perform in 2016 2019 and 2020 dynamic panel Doppler, which is usually done by calorie jet

injection, usually 10 or 20 milligrams, and you see that the systolic peak

velocity in this young guy on the right to the end of artery, it’s 19 centimeter

per. Second, with resistant index of less than 0.7 and the left to the end of 20

centimeter per second, with the resistant index again of less than 0.7 of course

the rolla gist, have suspected fibrosis of the corpora cavernosa at the doppler

examination. What I can tell you from my standpoint is that there is some mo

dynamic compromise, but it not seems to be so severe. We interrogated the patient

there is a questionnaire which is called if’ international index of erected

function score. That goes from 0 to 15. We give 5 question usually to the patients

and of course, 0 to 5 it’s a severe 5 to 10. It’s moderated in 10 to 15

it’s light erectile dysfunction. The patient has as a score five. So clinically speaking, he has a severe

erectile dysfunction, which does not respond anymore to phosphodiesterases

inhibitors is an tadalafil with no response with for more than one year, can

I have again the slides, so what we did due to the fact that the patient arrived

for this live case on Friday. We did an all monel laboratory test analysis, and you can clearly see that all

the almonds are quite normal. He has six point two LH, the free testosterone is

ten point three: it’s slightly increase compared to normal the three sex

hormone-binding protein, it’s sixty, which is again slightly increased compared to

the normal, but nothing really that we can justify this severe is

portion, Durant Eagle, approximately Abbas idea. Of course, what you can do in the

screening of these patients is to do a CT scan and geography, and you can

clearly see the right to the end of our very. This was done yesterday. Afternoon

The right, pudendal artery and the left to danville artery looks quite normal

this. Is a voxel gradient reconstruction on the right panel

so? Basically, of course, due to the fact that the case was not organized, this is a through world. The next slide

what we do approximately Abbas idea. As there are several zones

where, you can identify atherosclerosis disease in a CT scan. Usually the Atlas

carotid disease in the majority of cases is localized in zone four B, 5a and 5b so mid part of the internal pudendal artery

and distal part as at zone five in zone 5b, so as a common penile artery and or

Sully’s penis

Prasanna CC d, agua de Gracia. So basically the idea is as a first-line

treatment in this type of patient when you have an if’ score, which should be

less than 15 points

Pinal doppler, which is positive, as in this case and of course, positive penile

on, Josie T. If the patient does not respond to PDF 5 inhibitors, then second

line therapy for atherosclerosis is to do plain. Balloon angioplasty, followed by drug eluting, balloon treatment of the

pudendal artery. Then, of course, there is also a venous part which it’s

also important due to the fact that you have to think about a car tire if you

have a leak in the tire you can put as many airs that you want, but the tire

will not inflate so also the venous

parts needs to be good. But in this case it doesn’t seems that he has venous

leakage due to the fact that the index resistance is 0.7 normal, it’s 0.8. So of course, for demonstration, we will perform

with you a diagnostic evaluation. We know for sure that the artery are not

diseased, but what isn’t important that I would like to show you the projection

that you have to utilize in order to evaluate the

patience, the diagnostic part, it’s quite

complex due to the anatomical variables and the problems that you can encounter

in selecting the pudendal arteries. And, last but not least, we will give you a

glimpse on co2 and geography which we utilize every day to evaluate the

fibrosis of the corpora cavernosa. Due to the fact that co2 diffusion is much much higher compared to contrast, media and

the soul, you will rarely see corpora cavernosa. During contrast, injection you

can clearly see corpora cavernosa with co2 and, of course, if you don’t see the

corpora cavernosa with co2 injection, you will immediately think that there is a

problem at the level of the corpora cavernosa, such as micro, circulation

disturbance and, of course, fibrosis of the corpora cavernosa itself

now, if inch and so can show. Yes, there are questions only twelve of them yeah yeah. We will move. We will move to the

diagnostic part that we have done on the Left

pudendal artery if I can have the

registration that we have done. Of course, we start with a normal angiography of

the Caliph, or you can clearly see the two I pas gastric arteries here that are

normal, then we move in cross over and we check with different to bleed

projections the origin of the hypogastric artery. So, of course, now we

are selectively in the here in the hypogastric space can- and we are moving to the diagnostic projection

you- can clearly see the pudendal artery is the artery that runs on the right

side of the screen and then makes a small curvature going in the middle part

of, the patient. If I can have the next slides with other projections, you will

see that moving from oblique projection total, which is this one and you can

clearly, see the pudendal artery on the. Can I go back Vincenzo’s one second, so I

can show. Okay again, this is the pudendal. Is the artery

that crosses the screen that distribute in the middle of the screen itself? You

Have, the common renal artery as a last part and in the dorsal Peniel are tree

that. You slightly see going in the mid part of the screen. Now I want to show

you the co2 angiography, which is again this frame that we currently do as you

see the distribution of the gas is. Can we go to the next slide, so we can show the India lie. Friends, the the

complete angiography. You can clearly see, fir st of all, with one angel you

have, also the left to the endl artery that you clearly see on the left, with

the distribution. But if we, if we keep the co2, we will see the distribution on the cavernous body here in the last

frames, you can clearly see a small distribution of the

co2 on the Cavanaugh’s body, I’m telling you that this is a not a normal

distribution due to the fact that when you do have a normal distribution you

have an explosion of co2 within the corpora cavernosa

now, we will perform the contralateral injection just to evaluate also the tavernas body. We are utilizing. Mammary left, mammary artery in order to engage

so selectively, engage the contralateral artery. This is the left, mammary artery

and. Of course we were going to move on the contralateral side to evaluate were

the origin of the hypogastric artery is we are on the iliac Ricardo Can you

inject one second: can we increase a little bit more Lorenzo Namita Cinque

Cinque? Before we are so selecting the injection? We usually give 3 cc’s while

for Ilia. We move up to 5 or 7 injection. Okay, here is the hypogastric artery that

we selectively engage. Can you check? Okay, we are at the origin. Now we move with

the Roma wire, of course, to engage more deep, the artery and then perform with you

diagnostic and geography, as I told you. The most difficult part, especially at

the beginning, is to understand who is roux, because there are several arteries

originating from the hypogastric, which are mainly the gluteal arteries, inferior

and superior or internal or external, as you wish, we are probably here in a

gluteal, there are branches for bladder. There are branches for opt oratory

vessel. We are with the push and pull technique moving inside the gluteal

artery, and usually we start from there, the diagnostic part, so we have utilized

the contralateral view. Now we move to the Omo lateral view. We usually start

with an AP to understand the world. The pudendal artery is lorenzo Cinque Cinque

and. As you will see, the pudendal artery runs around the bladder okay. Here it is it’s the big branch that you

see here on the left that makes the curve around the bladder and distribute

in the middle part. Then we move usually to the causal alma lateral view, so we

are working here on the right. So we move to the total right to open a little bit

more. The artery lourenço go, and here it is again the curve and the

distribution very well that you see in the middle part of the screen. Of


This patient has nothing that needs to be treated. We will do also cranial view in order to better understand, especially in cases of

diffuse disease, where the stenosis are and again here it is okay. You see some small branches that distribute for the

prostate, which is slightly underneath the bladder and then at the end you see

the pudendal artery with the common and dorsalis penis bifurcation. Now we will

do co2 angiography has promised to evaluate the Father Knows health system. We are connecting the system and it is widow, can I have the slide again. One

Second I want to show you two in the alive friends

the co2 enjoy now go back one slide. Okay, you see manual injection. We at the

beginning of our experience. We were doing manual injection, but of course

first of all is not safe. We cannot give a consistent pressure and, of course, we

have a lot of radiation exposure, since we have to be very close to the patient

without. A body injection there is a

machine that is depicted in that slide. You have a very consistent pressure, we

inject that 300 dpi and 80 co2 as a volume, and this makes very reproducible any examination

now. You have to purge the system, Lorenzo -, CMO, furloughs Peugeot, and we again

move in this projection. Okay, right, okay, we start the injection and you will see

the co2 gas moving here. It is the pudendal artery. Don’t move, don’t move? Okay, you can see it the pudendal artery. It appears here on the left. And

Distribute in the middle part, you see a small distribution of co2 again due to

the fact that the viscosity it’s much less, as you have seen by contrast, you

cannot appreciate the cavernosa injection, but what is important is that

this. Distribution is not normal at all, due to the fact that we should have seen

a complete staining of all the Cavanaugh’s body for the entire segment

so for the entire organ, a genital organ. While we see only a very small

distribution at the base of the penis, but as you see along the penis, there is no distribution. So we agree with the urologists that probably this is a

fibrosis of the corpora cavernosa these pieces of information. It’s quite

important due to the fact that the patient does not respond anymore to PDF

inhibitors. You have that the nose is a clear diagnosis of fibrosis

and. Third, the only solution that we have in this type of patients is to do a pain

aisle implantation due to the fact that when there is fibrosis of the corpora

cavernosa, it’s likely micro

circulation in myocardial infarction is gone and, of course, you can also expect

that the pain. Island Plantation could be a more difficult procedure due to the

fact that the corpora cavernosa are

quite stiff and so for the urologist to enter with the surgical instrument, would

be more difficult than with I would say healthy, corpora cavernosa procedure. Now, having seen that what I would like to

show, you is our cases that we did this week just to give you the idea

of, what we have in case of atherosclerosis disease of the pudendal

artery Vincenzo’s may I have the video that we recorded and and, as you will see, with Diego, we have also the slide in case of

Arturo’s carotid disease. What we utilize is, as I told you, drug eluding, balloon and

it. It is which the only drug eluting balloon that we are utilizing now in our

catalog is a magic touch, which is an unique due to the fact that is a Sarala

mousse delivery. Do very nice engineering work has been done. The

Sarala mousse is converted into soup, micron-sized particles, with

encapsulation of sirolimus in karlie error, which is represented by

phospholipids, and then this courier n drugs are transferred into the vessel

wall for drug retention. Again, if I can have the other slide. Okay, this is the case that we have treated a couple of

days ago. You can clearly see here diffuse disease of the pudendal artery

here. It is. You can clearly see almost 90 percent stenosis of the pudendal artery

but very long segment. If we go to the next frame, you can see and appreciate a little bit better here in another

projection next frame. Okay, we are entering with 0.0 14 wire, avanti avanti. Okay, we are selecting with a guiding

catheter avanti. Okay here it is. You can clearly see the diffuse disease of the pudendal

artery district. We are almost at the base of the pain with the tip of the

why’re Avanti, of course, in this case is what we do. Usually we treat the most

severe segment with a drug-eluting. Stent in this case was a 2.5 stent, and then we move it. It is, and then we move with the

drug-eluting balloon after pre-delay tation to treat the other segments. And

You can clearly see that above the stand. Okay, this is the pre dilatation and then

we go with the drug eluting balloon próxima, the opposite, Eva. Okay, now we’re going to treat the distal part again. You

You can clearly see the disease in the distal segment, Proxima Proxima. Okay, probably this is the last one that the

balloon was not recorded, but this is the

result that we get after drug eluding, balloon implantation and the drug

eluting stent treatment of the these segments, and so what for screening? What is important for you, as a key message

and, take on message is that the co2 angiography can be done, of course, in

patient with the renal insufficiency, but is not this case, but in the pudendal

artery disease, in order to evaluate the response of the cavernous body to co2

injection. Second, if the rear there are stenosis at Ross, carotid disease, these

are, usually either Estrada clot, like in the coronary artery, the walls are

português study, demonstrating that we can have a type 5a and 5b of the

American artists

creation study classification, so complex plaque in this disk rest and you can

treat, with second line therapy with the drug, eluting, stent and, of course, drug

eluting balloon. In our case, we utilize sirolimus coating the balloon I don’t

know. If you have questions from the audience or from the panel, you did the right side were the left side normal

would, you do bilateral and you plus anytime. No, what we usually do. You have to keep in mind that there is also an

important psychological component in these patients and we treat them. Like

You know breast cancer. If they have to do a double implantation, they will first

do the left, breast and then the second breast, and we do the same. So we do a

diagnostic complete diagnostic angiography. Then we treat the most

severe side and stenosis. Then we wait three

four months and then we bring the patient back if he still has symptoms

because most of the time, the patient

responds very well, they withdraw completely. The PDF five inhibitors and

so we wait to treat the second side if we treat the patient only we drag

diluting balloon. We give a dual

antiplatelet therapy for three months and then on a sprain. It will continue on

aspirin if we have a drug-eluting stent the sides, it’s similar to the coronary

and. We give them six months at one antiplatelet therapy and then aspirin. Is it possible to diagnose that condition

prior to direct injection into the corpora cavernosa, showing that this is

going to be a five-door take cover? Note

Which means obviously, there’s going to be no possibility of any intervention is

that possible? This is a very good

question I mean we are talking about pioneering applications of co2

angiography. We are the only Center in the world that has started to do co2 on

geography in the pudendal artery

district. We never try, honestly speaking to do direct cavernosa injection we

performed routinely CT scan and geography with the cavern also tavern

orthography for venous disease. Due to the fact that you have to evaluate the

anatomy of the venous plexus. In order to do embolization, a

the patient has prevalently venous disease. We never inject co2 directly

into the cavernous tissue. It’s a good idea. We will. We will try doing the

cavern orthography to see what what we have but keep in mind that usually this

patient that comes with the positive

Doppler we don’t routinely perform CT angiography I will recommend

it to do it at the beginning to get orientation due to the fact that the

anatomy is quite complex in several cases, so CT angio will help the operator

to get oriented in this difficult Anatomy. We bring the patient immediately

in the cath lab it’s faster for us to do diagnostic and oco-2 angio and if we

have a stenosis, we treat them immediately very excellent description of how you evaluate and treat these

patients, and most of us are quite

unfamiliar with in this territory and you’ve, given us a very loose and step

back introduction to the topic for us. Thank you very much. You’re

Welcome master, namaste, namaste.

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Erectile dysfunction treatment Erectile dysfunction treatment options include medications, hormone therapy, surgery, and lifestyle changes. Medications for erectile dysfunction include phosphodiesterase type 5 inhibitors, hormones, and prostaglandin E1 analogues. Surgery...

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