Erectile dysfunction (ED)
The Supreme Vascular and Interventional Clinic is here to help restore your confidence, intimacy, and vitality through our comprehensive erectile dysfunction treatments. At our clinic, we offer erectile dysfunction solutions from Dr. Manish Taneja, our vascular specialist, to improve your quality of life and relationships since every moment of connection matters.
Introduction to Erectile Dysfunction
Male sexual response cycle has four phases: desire, arousal, orgasm and resolution.
There are multiple complex factors that are involved during a sexual response cycle.
Penis in a flaccid state is like any other organ in the body needing arterial blood flow into and venous blood flow out of the penis. The basic process of erection involves desire followed by increase in arterial blood flow to penis with arousal during which period the veins of the penis get engorged with no outflow of blood till the time ejaculation is achieved.
Incidence and Causes of Erectile Dysfunction
Erectile dysfunction is the inability to achieve or maintain an erection firm enough to have sexual intercourse. The disorder is highly age-dependent, as the combined prevalence of moderate to complete erectile dysfunction rises from approximately 22% at age 40 to 49% by age 70. Although less common in younger men, erectile dysfunction still affects 5%-10% of men below the age of 40.
- There are multifactorial organic or psychological causes of erectile dysfunction. These may include high blood pressure, high cholesterol, diabetes, peripheral vascular disease, excessive stress, obesity, family history of atherosclerosis, smoking, anxiety and hormonal disorders.
Common Clinical Presentation
Erectile dysfunction is seen across all age groups. There are two main issues that are encountered in clinical practice. First is the inability to achieve an erection. The second is inability to sustain or maintain an erection.
One of the causes of inability to achieve an erection is poor circulation with inadequate arterial blood supply to the penis during an erection.
In our local practice, a large number of patients present with this problem of maintain an erection. One of the major vascular causes of inability to sustain or maintain an erection is venous leak.
Assessment of Erectile Dysfuction
Assessment of erectile dysfunction involves clinical and hormonal assessment follow by radiological tests. These include:
- Doppler ultrasound scan: This is an extremely useful test to assess for vascular causes of erectile dysfunction. The scan has a high degree of accuracy and is a useful test to guide further management in conjunction with the history.
- Cavernosography – This is an invasive test done in special circumstances.
Treatment of Vasculogenic Erectile Dysfunction
Erectile dysfunction is a complex disorder with many causes. Multiple treatment options are available depending on the underlying cause. For patients with vascular cause of erectile dysfunction, the following treatments are available
1. Medical therapy: there are multiple drugs available that are very effective in treating physical symptoms
2. Surgical intervention
3. Endovascular interventional procedures: These latter are day surgery procedures done under sedation with quick recovery within a day . There are two categories of endovascular procedures available. These are both done at same time in most patients in a single session of treatment of about 60-90 minutes.
3A. Arterial inflow procedure (angioplasty/stenting): these involve access using tiny 2 mm incision in the artery of the groin or wrist. Small tubes called catheters are advanced into the arteries all the way to check if there is any blockage in arterial flow to the penis. The blood flow is opened up as required using balloon dilatation or stenting of blocked arteries. Occasionally, there are arteriovenous connections called fistula seen on angiogram stealin arterial blood from the penis that can be treated at same time.
3B. Venous leak embolization: this involves direct access of one of the draining veins under the skin of penis under ultrasound guidance. The site of leak is identified in the pelvis and occluded using surgical glue or occasionally dedicated occlusive coils using the same approach. We also treat other issues such as varicolece and benign prostate hyperplasia apart from erectile dysfunction.
Other Health Conditions
The Supreme Vascular and Interventional Clinic is your “go-to” facility for various conditions and treatments and specialized care for male health issues. To arrange an appointment with Dr. Manish Taneja, our vascular specialist, contact us. You can also call us at (+65) 6904 8084 for a consultation.