Internal Pudendal Artery Stenoses and Erectile Dysfunction: Correlation With Angiographic Coronary Artery Disease

OBJECTIVES: Erectile dysfunction (ED) and coronary artery disease (CAD) share common risk factors which can result in endothelial dysfunction, atherosclerosis and flow-limiting stenoses in the coronary and internal pudendal arteries. To describe the angiographic characteristics of pelvic arterial disease in patients with ED nonresponsive to phosphodiesterase-5 inhibitors (PDE5i) and suspected CAD.

METHODS: Ten patients undergoing cardiac catheterization with ED and a history of unsatisfactory response to a PDE5i were studied. ED severity was quantified using the International Index of ED scoring system. We performed angiography and quantitative vessel analysis of the coronary arteries, bilateral common and internal iliac arteries, and internal pudendal arteries (IPAs).

RESULTS: In this pilot observational study, we found a high correlation between the presence of angiographic CAD and IPA disease. The reference IPA diameters at the point of maximal stenosis were 2.7 ± 0.4 mm (right IPA) and 2.7 ± 0.5 mm (left IPA). In the nine patients with IPA disease, the average stenosis severity was 55 ± 31% (right) and 66% ± 25% (left), and average lesion length was 12.4 ± 5.2 mm (right) and 10.0 ± 3.5 mm (left). Four patients had unilateral IPA total occlusions, three of whom had moderate contralateral disease. The majority of IPA stenoses occurred in the mid to distal IPA and appears amenable to percutaneous revascularization.

CONCLUSIONS: This represents the first angiographic report of CAD correlated with IPA disease in patients with ED. Further investigation is required to determine whether the development of macrovascular disease in the IPA causes ED and whether endovascular treatment is safe and effective in this population.

PMID: 20928837

Posted in Invasive Imaging and tagged , , , , .


  1. ZEN results raise early hopes for DES in erectile dysfunction.
    Shelley Wood.
    HeartWire. October 19, 2011.

    Las Vegas, NV – Thirty-day and three-month results from an eagerly-awaited first trial to test a drug-eluting stent for the treatment of erectile dysfunction suggest that this novel use for a DES is safe, and associated with significant improvement in erectile function and satisfaction. But the trial also encountered logistical problems related to the uncharted complex terrain of the pelvic vasculature, meaning that the next trial in this arena is going to take a step back.

  2. It seems that Department of Urology will be a branch of the Department of Cardiology. Two become one. 🙂

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