Endovascular therapy for erectile dysfunction: insights from more than 1000 treatments

BACKGROUND: To report effectiveness and patient-reported satisfaction after endovascular treatment of vasculogenic erectile dysfunction (ED) in a large registry cohort. METHODS: Erectile function was assessed using the International Index of Erectile Function (IIEF) questionnaires. Endovascular treatments included revascularization of arterial obstruction and/or venous leak embolization. Safety endpoints included the absence of device- or procedure-related major adverse events. Patient satisfaction was measured at 6 weeks using the Patient Global Impression of Improvement (PGI-I) questionnaire. RESULTS: According to the SwissPower registry, 1032 endovascular procedures were performed on 776 patients, thereof 524 patients received at least one arterial revascularization, and 188 men underwent at least one venous embolization. Of note, 64 patients underwent both venous plus arterial procedures during the study period. Among patients with available follow-up IIEF-6 data, a ≥ 4-point improvement was observed in 175/402 men (44%) after arterial revascularization at 30 months, in 62/140 men (44%) after venous leak embolization at 9 months, and in 28/54 men (52%) after combined arterial plus venous interventions at 21 months. According to PGI-I, patients reported improved erectile function after arterial revascularization in 61% (226/369), venous leak embolization in 72% (102/142), and combined arterial plus venous interventions in 68% (38/56). Overall, 400/554 men (72.2%) reported that they would undergo the procedure again: 67.4% after arterial intervention, 78.7% after venous embolization, and 87.5% after combined arterial plus venous interventions. CONCLUSIONS: In this large registry cohort, endovascular treatment for vasculogenic erectile dysfunction was associated with clinically meaningful improvement of erectile function in the majority of patients.