ERECTILE DYSFUNCTION
Introduction
The term erectile dysfunction describes the inability to achieve and/or maintain an erection during sexual intercourse. If a man experiences erection problems occasionally, this in itself may not necessarily be considered something worrying, as various factors may be responsible for this condition. In the case however where erectile dysfunction is a persistent problem, it can cause anxiety, affect self-confidence, as well as the romantic relationships of the patient.
Erectile dysfunction is a condition that can have many different causes. In 60-80% it is of vascular etiology, in 10-20% of neurological etiology, in 10-15% of pharmacological etiology and in 5-10% of hormonal etiology. It is very important for the male population to know that 50% of men develop erectile dysfunction before the appearance of coronary artery disease, which is why erectile dysfunction is a condition that should be reported without taboo to the cardiologist.
The timely early diagnosis of the disease
is very important
for the good outcome of the condition in both stages of the disease.
Understanding Erectile Dysfunction of vascular etiology
Based on research in patients with erectile dysfunction of vascular etiology, 75% of patients present with stenosis or obstruction in the artery that supplies blood to the penis. This leads to reduced blood supply to the penis and unsatisfactory filling of the reservoirs that cause erection in the penis and are called cavernous bodies. In patients with diabetes or metabolic syndrome the larger vessels are normal while the capillary vessels of the cavernous bodies present obstructions which again do not allow the filling of these reservoirs. Both conditions lead to erectile dysfunction.
Ποιες είναι οι επεμβατικές μέθοδοι χειρουργικής θεραπείας;
Erectile Dysfunction: Symptoms
Erectile dysfunction manifests with difficulty achieving and/or maintaining an erection sufficient for sexual intercourse. The symptoms may appear progressively or suddenly, depending on the etiology of the condition.
In the case of vascular erectile dysfunction, erection is often achieved partially but is not maintained, while the man may notice:
- reduction in the hardness or duration of the erection,
- inability to achieve erection after normal sexual stimulation,
- gradual deterioration of sexual function over time,
- absence of spontaneous morning or nocturnal erections.
In men with diabetes, hypertension, dyslipidemia or smoking, the above symptoms constitute an early warning sign of vascular disease and are often associated with the presence of coronary or peripheral arterial disease.
For this reason, erectile dysfunction should be treated not only as a quality of life problem, but also as a potential vascular symptom that requires investigation.
Erectile dysfunction: Diagnosis & Treatment
Erectile dysfunction: Diagnosis & Treatment vascular surgeon The diagnosis of vascular dysfunction of erectile dysfunction is performed by the treating urologist-andrologist in the context of an ultrasound examination and triplex of the penis. If the involvement of the arteries in the problem is confirmed, the immediate initiation of pharmaceutical treatment is recommended. If improvement does not occur after 3-6 months, the patient may be referred to the treatment of erectile dysfunction
Αντιμετώπιση της Στυτικής Δυσλειτουργίας
The treatment of vascular erectile dysfunction is ideally performed in a hybrid clinic, a specialized space that combines advanced imaging and navigation systems inside the vessels with top aseptic conditions. This environment allows the safe and precise performance of minimally invasive procedures, while maintaining at the same time the possibility of immediate transition to open surgery if needed.
During the vascular surgery ultra-selective catheterization of the arteries of the penis is performed. In the case of stenosis or obstruction, the doctor proceeds to angioplasty using a drug-coated (paclitaxel) balloon. If the result is not satisfactory, the placement of a drug-coated endograft (stent) is considered necessary. Also of decisive importance is the performance of diagnostic angiography with carbon dioxide for the cavernous bodies. Carbon dioxide has a low viscosity that allows it to diffuse inside the microcirculation of the cavernous body if it does not present blood supply problems. In diabetic patients with microcirculation problems in the cavernous bodies, carbon dioxide cannot diffuse. This is an important diagnostic finding that can help the andrologist to suggest more quickly more invasive and effective methods of restoring erectile function (e.g. placement of a penile prosthesis).
The role of the vascular surgeon in the treatment of erectile dysfunction
The vascular surgeon plays a decisive role in the treatment of vascular erectile dysfunction, especially when the intervention is performed in a hybrid clinic. He undertakes the navigation and restoration of blood supply to the penis through angioplasty procedures, placement of drug-coated balloons or endografts, ensuring at the same time complete asepsis and safety of the surgical field. His experience is crucial for the interpretation of diagnostic angiography and the selection of the most appropriate method of restoring erectile function. For more information Get in Contact with the Vascular Surgeon, Dr. Theodosis Bisdas
Frequently Asked Questions (FAQs)
Is it normal to have occasional erection problems;
Yes. Factors such as stress, fatigue, alcohol consumption or the pressure of everyday life can temporarily affect erection. However, when the difficulty persists or recurs frequently, medical investigation is needed.
Which doctor should I go to for erectile dysfunction;
The first choice is to turn to an experienced urologist-andrologist, as he has the specialization in male sexual health. In cases where the cause appears to be vascular (e.g. presence of arterial stenoses), collaboration with a vascular surgeon is indicated, so that the vessels and circulation can be evaluated.
What tests are needed for the diagnosis of erectile dysfunction;
The diagnosis begins with taking a complete medical/sexual history and clinical examination, continues with basic laboratory tests (testosterone, glucose, lipids, renal/hepatic) and, where indicated, imaging examination with ultrasound-Triplex of the penis; if a vascular cause is established, diagnostic angiography follows for precise assessment and treatment selection.
Can erectile dysfunction appear in young men;
Yes. Although the probability increases with age, erectile dysfunction is not "only for older men". Studies show that it also appears in younger ages, usually in combination with factors such as stress, smoking, diabetes, obesity or vascular problems.
Can I prevent erectile dysfunction;
Prevention is based on vascular health: smoking cessation, regular exercise, proper nutrition, regulation of blood sugar, blood pressure and cholesterol. Timely diagnosis plays a decisive role in successful treatment.
