Vasculogenic ED (Erectile Dysfunction) Program at University Hospitals

What Is Vasculogenic Erectile Dysfunction?

When a male becomes sexually aroused, the blood vessels in the penis relax and expand so that blood fills the two chambers of sponge-like erectile tissue, called the corpora cavernosa, that run the length of the organ. Blood becomes trapped under high pressure in the erectile tissue to produce an erection.

ED, also called impotence, is divided into two categories: organic and psychogenic. Psychogenic ED is psychological in origin. Organic causes of ED are subdivided into vasculogenic, neurogenic and hormonal types. Representing the most common type of ED overall, vasculogenic ED occurs when the arteries and/or veins that bring blood to and from the penis, respectively, are not functioning correctly due to blockages, narrowing or other physiological causes. Vasculogenic ED encompasses two main types:

• Arteriogenic ED, or arterial ED, occurs when atherosclerosis (buildup of cholesterol plaque in arteries) causes a blockage in one more of the arteries that supply blood to the penis.
• Venogenic ED – also called venous ED, VED, venous leak or venous leak syndrome – is when the inflow of arterial blood flow to the penis is sufficient, but outgoing blood drains too rapidly from the erectile tissue to maintain a normal erection for the duration of sexual intercourse.

What Are Vasculogenic Erectile Dysfunction Causes and Risk Factors?

The primary causes and risk factors for arterial ED are health conditions that cause or contribute to the narrowing or blockage of blood vessels, including:

• Peripheral artery disease (clogged arteries in the legs or lower extremities)
• Coronary artery disease (clogged arteries in the heart)
• High blood pressure
• High cholesterol
• Diabetes
• Obesity

Causes and risk factors for venous leak are similar to those for arterial ED but also include:

• Peyronie’s disease (a buildup of scar tissue in the penis that causes curved, painful erections)
• Certain neurological disorders
• Excessive anxiety or stress

How is Vasculogenic Erectile Dysfunction Diagnosed?

For men experiencing ED symptoms, University Hospitals recommends a full evaluation by a urologist at University Hospitals Urology Institute, including blood testing and ultrasound of the penis and pelvis.

If your initial examination and testing suggest your ED is likely to be arterial, the urologist will refer you to an endovascular specialist at University Hospitals Harrington Heart & Vascular Institute. The endovascular specialist will use one or more of the following imaging techniques to locate any arterial blockages that could be the cause of your ED:

In diagnosing venous ED, the doctor may use one or both of the following tests:

• Doppler Ultrasound: This procedure uses sound waves to show how blood is flowing in and out of the penis.
• Dynamic Infusion Cavernosometry: In this test, a doctor measures pressure in the penis during an erection to determine the degree of venous leakage. Cavernosometry is usually used in men who have already had a Doppler ultrasound that indicated venous leakage.

Vasculogenic Erectile Dysfunction Treatment

Non-Invasive Treatments

• Phosphodiesterase Type-5 Inhibitors (Viagra, Cialis, Levitra and Stendra) taken in pill form
• Testosterone Therapy if blood testing indicates low testosterone levels
• Intracavernosal Injection: direct injection of potency-enhancing medications such as prostaglandin E1, papaverine and phentolamine into the penis
• Intraurethral Medication/Urethral Suppository: medication administered as a small tablet that is inserted directly into the urethra; specific medications introduced this way include vasodilators (drugs that increase blood flow by expanding blood vessels) such as alprostadil

Minimally Invasive Endovascular Procedure and Other Treatments

If initial tests indicate blockage or narrowing of the arteries that carry blood into the penis, a vascular doctor may recommend a minimally invasive endovascular intervention. In this procedure, an endovascular specialist utilizes angioplasty to fix the blockages responsible for preventing sufficient blood flow to the penis.

Other vasculogenic ED treatments available through University Hospitals’ vasculogenic ED program that may be recommended after other treatments for ED have failed include the following:

• Penile Arterial Surgery: In this procedure, the surgeon transfers an artery from behind the abdominal muscle to a penile artery to create a path to the penis that bypasses the area of the blocked artery inhibiting blood flow to the penis.
• Penile Vein Ligation: In cases of positively confirmed venous leakage, the doctor may recommend surgery to close off (ligate) some of the penile veins so that the penis can better trap the amount of blood needed to maintain an erection.
• Penile Implants: Penile implants are devices surgically placed inside the penis to help men with ED obtain an erection.