Incidental findings during computed tomographic angiography diagnostic work-up in patients with arteriogenic erectile dysfunction

Abstract

AIM: To analyse the incidental findings during computed tomographic angiography (CTA) diagnostic work-up in patients with arteriogenic erectile dysfunction (ED). PATIENTS AND METHODS:The medical records of all patients with suspected arteriogenic ED were entered into a database. Risk factors and underlying comorbidities were also collected. Pathological CTA findings were extracted from the CT readings and entered into the database. Incidental findings on CTA were classified as those requiring immediate medical treatment, requiring deferred medical treatment or of no clinical importance. RESULTS: A total of 200 patients underwent CTA for suspected arteriogenic ED. Mean patient age was 59.6 ± 11.7 years. Of these, 181 patients (90.5%) had obstructions of erection-related arteries. In 168 patients (84.0%), CTA showed multiple incidental pathological findings. Eightyfive of 200 patients (42.5%) exhibited incidental findings requiring immediate further medical workup and/or treatment: coronary artery calcification was diagnosed in 75/ 200 (37.5%), aorto-iliac aneurysms in 8/200 (4%) of patients and incidentally detected embolism in 1/200 patient. Pancreatic and liver tumours were less frequent (incidence 1.5% and 1%, respectively). Incidental findings requiring deferred medical workup and/or treatment were detected in 175/200 patients (87.5%). The findings with the highest prevalence were liver steatosis followed by colon diverticulosis and prostate hyperplasia. Findings of little to no clinical importance were reported in 117 (58.5%) patients. These included uncomplicated renal cysts, spinal degeneration and renal vascular anomalies. Almost every second patient presenting with ED had an incidental finding which required immediate treatment. CONCLUSIONS: Incidental findings not directly related to ED were common among patients undergoing CTA scans for suspected arterial obstructions. Coronary artery calcification was the leading finding requiring further medical workup and/or treatment. Thus, the benefit of CTA investigations extends beyond the anatomic description of arterial obstructions of erection-related arteries.

Erectile dysfunction and coronary artery calcification in incident dialysis patients

“…It was also hypothesized that the small penile arteries are more susceptible to progressive occlusive disease than the larger coronary arteries [24] and can predict coronary artery disease. In a study of 200 patients with suspected arteriogenic erectile dysfunction, 90.5% of the patients had obstruction of erection-related arteries and 37.5% had coronary artery calcification [8].…”

“…It has been found to predict individuals at high-risk for cardiovascular disease and mortality in dialysis patients [6], and its progression has been associated with mortality in subjects with kidney failure [7]. Coronary artery calcification was found in 37.5% of individuals who were being evaluated for suspected arteriogenic erectile dysfunction [8] the severity of which has been associated with higher coronary artery calcification score [9].…”

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

“…Arousal dysfunction can occur from direct damage to the functional erectile and pelvic tissues, injury to the supplying neurovasculature, or impaired blood flow preventing genitopelvic tissue engorgement 4,42,152,153 . During RAI, people might transiently lose an erection as other areas are stimulated and blood is diverted from erectile tissues; however, diseases and treatment-related sequelae can further shunt blood flow away from pelvic and erectile structures, further decreasing arousal and ultimately delaying orgasm or altogether preventing it 4,42 .…”

“…Pelvic and anal muscular contractions can inhibit venous return from the haemorrhoid plexus, further inhibiting functional blood circulation during RAI 177,178 . Diverticular diseases might be associated with erectile dysfunction through physical vessel blockage, inflammation and vasculopathies preventing blood flow to erectile tissues 152,153 . Structural disorders can also influence sexual desire through changes to the physical appearance of the anus, which might result in self-consciousness and decreased desire to engage in RAI 179,180 .…”

“…if surgical management, consider anal dilator to remodel scar Internal haemorrhoids ↓ Arousal: shunt blood away from erectile tissues 177,178 Can engage in RAI; increase fibre intake to decrease straining 177,178 Rectal prolapse ↓ Arousal: decreased sphincter tone ↓ Desire: mucus discharge and change to anal appearance 179,180 Can engage in RAI; increase fibre intake; perform sphincter exercises; surgery can be considered 412 Perirectal abscess AD: pain from abscess at baseline Abscess drainage before re-engaging in RAI Colonic polyps ↓ Arousal: vessel blockage, ↓ blood to erectile tissues 152,153 Can engage in RAI; increase fibre intake Anorectal fistula AD: pain during penetration if filled with fluid 167 ; setons in situ can be uncomfortable 272 ↓ Arousal: sphincter damage 240,247 from fistula or surgery 240 Dysorgasmia: scarring causing tightening 167 ↓ Desire: anxiety from leakage, anus changes 167,179,180 , setons in situ can be deforming 272 Can engage in RAI if no pain and no draining; consider knotless setons to mitigate painful RAI and effects on desire 272 ; consider advancement flap 240 or ligation 240 to preserve sphincter function (if candidate)…”