A vascular cause should be considered in particular if symptoms develop gradually and risk factors such as smoking, diabetes mellitus, high blood pressure, elevated blood lipids, or a known vascular disease are present. In cases where the cause is arterial, insufficient stiffness is often the primary issue, frequently accompanied by a limited response to medication.
A venous leak may be suspected if an erection is achieved but cannot be maintained for a sufficient length of time. A so-called venous leak is a more common cause in younger patients. At the Department of Angiology, we offer specialized vascular evaluation for men in whom a vascular cause is suspected.
Diagnostics
The evaluation includes a targeted medical history and modern vascular diagnostics. The most important test is dynamic duplex ultrasound of the penis. In this procedure, arterial blood flow and venous outflow are examined following pharmacological stimulation of the corpus cavernosum. This makes it possible to determine whether the cause is an arterial circulatory disorder, a venous leak, or a combination of both. This can be supplemented with advanced imaging techniques such as CT angiography, CT cavernosography, or angiography.
If necessary, additional imaging tests can be performed to provide a more detailed view of the vascular anatomy and to evaluate possible treatment options.
Treatment
The treatment depends on the cause. General measures such as quitting smoking, exercising, losing weight, and properly managing blood pressure, blood sugar, and blood lipids are important. Medications such as PDE-5 inhibitors—for example, sildenafil or tadalafil—can also be helpful.
If a relevant vascular problem is detected, we discuss with the patient whether endovascular treatment is an option. In certain cases, minimally invasive procedures are possible, such as balloon dilation or stent placement for arterial narrowings, or embolization for confirmed venous leaks.
Successful vascular treatment may lead to improved erection firmness, longer-lasting erections, and, in some cases, a better response to medication. The expected benefits depend on the type and severity of the vascular problem and will be discussed on an individual basis before any treatment is considered.
Interdisciplinary Care
Erectile dysfunction can also be a sign of other medical conditions. For this reason, the evaluation is conducted, if necessary, in collaboration with colleagues from the departments of urology, endocrinology, and cardiology. The goal is to provide comprehensive, personalized, and modern treatment.
