Erectile Dysfunction

Nuffield Vascular and Interventional Radiology (NVIR) is dedicated to helping you regain confidence, intimacy, and vitality with our comprehensive erectile dysfunction treatments. We provide tailored solutions to enhance your quality of life and strengthen your relationship.

What is Erectile Dysfunction?

The male sexual response cycle consists of four distinct phases: desire, arousal, orgasm, and resolution.

A variety of complex factors influence this cycle.

In its flaccid state, the penis functions like any other organ in the body, requiring arterial blood to flow in and venous blood to flow out. The process of achieving an erection begins with desire, leading to increased arterial blood flow to the penis during arousal. At this stage, the veins within the penis become engorged, restricting blood outflow until ejaculation occurs

What causes Erectile Dysfunction?

Erectile dysfunction (ED) is defined as the inability to achieve or sustain an erection sufficient for sexual activity. The condition is strongly associated with age, with the prevalence of moderate to severe ED increasing from approximately 22% in men aged 40 to 49% in those aged 70. While less common among younger men, ED still affects 5% to 10% of men under the age of 40.

The causes of erectile dysfunction are multifaceted, encompassing both organic and psychological factors. These may include conditions such as high blood pressure, high cholesterol, diabetes, peripheral vascular disease, excessive stress, obesity, a family history of atherosclerosis, smoking, anxiety, and hormonal imbalances.

What are the common signs or symptoms of Erectile Dysfunction (ED)?

Erectile dysfunction (ED) occurs across all age groups and typically presents with two primary issues in clinical practice: (1) the inability to achieve an erection and (2) the inability to sustain or maintain one.

A common cause of difficulty in achieving an erection is poor circulation, resulting from insufficient arterial blood flow to the penis during arousal.

In clinical practice, a significant number of patients report challenges with maintaining an erection. One of the primary vascular causes of this issue is a condition known as venous leak, where the veins fail to retain blood within the penis, compromising the erection.

How do we evaluate an ED?

The evaluation of erectile dysfunction involves a combination of clinical, hormonal, and radiological assessments. These include:

Doppler Ultrasound Scan: A highly accurate and valuable test for identifying vascular causes of erectile dysfunction. This scan provides critical insights that, when combined with the patient’s history, can effectively guide further management.
Cavernosography: An invasive procedure performed in specific cases where additional detailed investigation is required.

What are the treatment options for ED?

Erectile dysfunction (ED) is a multifaceted condition with various underlying causes, and treatment options are tailored to address these specific causes. For patients with vascular-related ED, the following treatments are available:

Medical Therapy: A range of medications is available to effectively address the physical symptoms of ED.
Surgical Intervention: Certain cases may require surgical procedures to correct anatomical or vascular issues.
Endovascular Interventional Procedures: These minimally invasive, day-surgery procedures are performed under sedation and typically allow for same-day recovery. Two main categories of endovascular treatments are often conducted in a single session lasting about 60–90 minutes:

- 3A. Arterial Inflow Procedure (Angioplasty/Stenting):
  - This procedure involves accessing the artery through a tiny 2 mm incision in the groin or wrist.
  - Catheters are guided into the arteries to identify blockages affecting blood flow to the penis.
  - Blocked arteries are treated using balloon dilation or stenting to restore proper blood flow.
  - Occasionally, arteriovenous connections (fistulas) that divert arterial blood away from the penis are detected and treated during the same procedure.

- 3B. Venous Leak Embolisation:
  - This involves ultrasound-guided access to a draining vein beneath the skin of the penis.
  - The site of the venous leak is located within the pelvis and sealed using surgical glue or, in some cases, specialised occlusive coils.
  - Additional conditions, such as varicoceles or benign prostatic hyperplasia, can also be addressed during the same treatment session.

These approaches offer comprehensive solutions to manage vascular causes of ED effectively, improving patient outcomes.

Your Health, Our Priority

I’m here to help you regain control of your health. Together, we’ll manage your symptoms and prevent future complications using personalised care and innovative technology. – Dr Suresh Babu