Hypertension and erectile dysfunction: The role of endovascular therapy in Asia

Tzung-Dau Wang, Chih-Kuo Lee, Yook-Chin Chia, Kelvin Tsoi, Peera Buranakitjaroen, Chen-Huan Chen, Hao-Min Cheng, Jam Chin Tay, Boon Wee Teo, Yuda Turana, Guru Prasad Sogunuru, Ji-Guang Wang, Kazuomi Kario, HOPE Asia Network, Tzung-Dau Wang, Chih-Kuo Lee, Yook-Chin Chia, Kelvin Tsoi, Peera Buranakitjaroen, Chen-Huan Chen, Hao-Min Cheng, Jam Chin Tay, Boon Wee Teo, Yuda Turana, Guru Prasad Sogunuru, Ji-Guang Wang, Kazuomi Kario, HOPE Asia Network

Abstract

The prevalence of erectile dysfunction (ED) is above 40% in both Asian and non-Asian male populations after the age of 40 years. The prevalence of ED among hypertensive patients is approximately double than that in normotensive population. Pelvic arterial insufficiency is the predominant cause of ED in men aged over 50 years. Stenosis in any segment of the iliac-pudendal-penile arterial system, which is considered an erectile-related arterial axis, could lead to ED. Pharmacotherapy with lifestyle modification is effective in alleviating sexual dysfunction, yet a substantial number of patients still develop ED. Given the established applicability of angioplasty for the entire iliac-pudendal-penile arterial system, penile duplex ultrasound, and pelvic computed tomography angiography could be considered as the routine screening tools in ED patients with poor response to phosphodiesterase-5 inhibitors. Endovascular therapy for pelvic arterial insufficiency-related ED has been shown to be a safe and effective treatment option in patients who have anatomically suitable vessels and functionally significant stenoses. Clinical improvement was achieved in over 60% of patients at one year following pelvic angioplasty in the PERFECT registry from Taiwan. A 30%-40% restenosis rate in distal internal pudendal and penile arteries remains a hurdle. Angioplasty for pelvic arterial occlusive disease could be considered as a viable approach to arteriogenic ED.

Keywords: Asian patients; atherosclerosis; hypertension; sexual dysfunction; vascular disease.

Conflict of interest statement

TD Wang has received honoraria from Abbott, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Medtronic, Menarini, Novartis, Omron, Pfizer, Sanofi, and Servier. YC Chia has received honorarium and sponsorship at attending conferences and seminars from Boeringher‐Ingelheim, Pfizer, Omron, Servier, and Xepa‐Sol and an investigator‐initiated research grant from Pfizer. Peera Buranakitjaroen have no conflict of interest, except a research grant from Pfizer (Thailand) Limited, as mentioned in the paper. CH Chen reports personal fees from Novartis, Sanofi, Daiichi Sankyo, SERVIER, Bayer, and Boehringer Ingelheim Pharmaceuticals, Inc HM Cheng received speakers honorarium and sponsorship to attend conferences and CME seminars from Eli Lilly and AstraZeneca; Pfizer Inc; Bayer AG; Boehringer Ingelheim Pharmaceuticals, Inc; Daiichi Sankyo, Novartis Pharmaceuticals, Inc; SERVIER; Co., Pharmaceuticals Corporation; Sanofi; TAKEDA Pharmaceuticals International; Menarini Co., Ltd.; and served as an advisor or consultant for ApoDx Technology, Inc JG Wang reports having received research grants from Chendu Di‐Ao and Omron, and lecture and consulting fees from AstraZeneca, Novartis, Omron, Servier, and Takeda. K Kario reports research grants from Omron Healthcare, Fukuda Denshi, A&D, Pfizer Japan, and honoraria from Omron Healthcare. All other authors report no potential conflicts of interest in relation to this article.

© 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
The 8‐zone segmentation scheme of the iliac–pudendal–penile arterial system shown in reconstructed pelvic computed tomography angiography

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