V12-03: Dynamic Magnetic Resonance Angiography in Men with Idiopathic Erectile Dysfunction
Young men presenting with erectile dysfunction (ED) often have a psychogenic etiology; however, some of these men do not respond to medical therapy, have abnormal duplex ultrasounds, and have suspected aberrant penile vasculature contributing to ED. With the advent of magnetic resonance angiograms (MRA), penile evaluation can now benefit from temporospatial resolution previously unobtainable. The objective of this study was to use MRA in evaluation of young men with suspected aberrant vascular anomalies contributing to erectile dysfunction.
Patients presenting with erectile dysfunction underwent duplex ultrasound (DUS). Men with signs of early shunting of blood were selected to undergo MRA. Patients underwent injection with 4-6 times their regular amount of erectogenic agent used at home (trimix, or super-trimix) prior to the MRA. Erection grade was assessed prior to MRA and just following the study to ensure adequate erection was present. A Siemens Skyra 3 Tesla scanner was used with a 32 channel external phased array. The protocol included a weight-based injection of gadolinium contrast 15 seconds prior to initiation of scanning. Images were acquired with 1mm slice thickness every 5 seconds. 3-D reconstructions were performed with Vital Images Vitrea.
Seven patients were included in this case series with a mean age of 34. Three men previously used intracavernosal injections, and all used phosphodiesterase inhibitors. Upon MRA evaluation, all studies demonstrated early venous drainage. Four men were found to have suspected arteriovenous malformations. Non-classical arterial supply to the penis was demonstrated in 3 patients. One subject had a direct shunt from the left cavernosal artery to the pelvic venous drainage. Two subjects underwent selective venous ligation with early improvement of self-reported erections.
MRA evaluation for young men with suspected vasculogenic ED serves as a useful tool to identify arterio-venous shunting and the etiology of ED. These men may then undergo selective ligation to correct their aberrant vasculature with hopes for restored erections. Further study is needed to assess long term outcomes.