Variations of the internal pudendal artery as a congenital contributing factor to age at onset of erectile dysfunction in Japanese

Abstract

basic type), in which the internal pudendal artery (IPA) originates from the anterior trunk at the level between the linea terminalis and the major ischial notch; Type 2, the IPA originates from the anterior trunk of the IIA at the level of the major ischial notch or more distally; Type 3, the IPA originates directly from the IIA at a level proximal to the linea terminalis; Type 4, the IPA originates together with the superior and inferior gluteal artery within 1 cm of each other; and Type 5, the penile blood supply is dependent on arteries other than the IPA, such as the obturator artery. RESULTSAmong the 290 units, eight could not be classified due to poor image quality. There were no statistically significant differences in blood flow parameters among the types of IIAs, but there was a statistically significant difference in the IPA type at the age of onset of ED. Type 1 (153 units or 53%) anatomy, was more common in patients who developed ED at an advanced age. Types 2, 3 and 4 were more common in patients with onset of ED at an early age (log-rank test P < 0.001, Study Type -Prognosis (outcomes research) Level of Evidence 2c OBJECTIVETo investigate the relationship between variations of the pelvic artery arrangement and the age at erectile dysfunction (ED) onset, as some men develop ED while relatively young, while others maintain erectile function into old age despite having cardiovascular diseases, thus congenital factors might be involved. PATIENTS AND METHODSWe examined 290 units of internal iliac arteries (IIA) in 145 patients showing repeated incomplete erectile response to intracavernosal injections with prostaglandin E 1 . Patients with cardiovascular risk factors, neurological disease or pelvic injury were excluded. The pelvic artery arrangement, evaluated by three-dimensional computed tomographic angiography, was classified anatomically into five types: Type 1 (normal or

Clinical and metabolic evaluation of subjects with erectile dysfunction: a review with a proposal flowchart

“…, 2005) some patients with severe CAD still report normal erectile function. Interestingly, recently Kawanishi et al. (2008) demonstrated that congenital vascular abnormalities could explain, at least partially, this apparent incongruence.…”

“…Finally, it should be recognized that although the prevalence of ED in subjects with CAD is quite high (Montorsi et al, 2005) some patients with severe CAD still report normal erectile function. Interestingly, recently Kawanishi et al (2008) demonstrated that congenital vascular abnormalities could explain, at least partially, this apparent incongruence.…”

Variations of the Internal Pudendal Artery as a Congenital Contributing Factor to Age at Onset of Erectile Dysfunction in Japanese

“…Kawanishi et al. [1]. reported this retrospective radiological study examining the effect of different anatomical variations of the internal pudendal artery on the development of erectile dysfunction (ED) in young or older patients.…”

“…In our studies we mainly focused on the dorsal nerve of penis, but paper of Kawanishi et al. [1], on the current knowledge of clinical anatomy of the subpubic region, lead me to the conclusion that it might be very interesting to study anatomical variations of the penile‐supplying arteries in the subpubic region.…”

“…Thus, Kawanishi et al. [1] had an unique chance to study the occurrence of ED in different groups of patients in relation to the anatomical variability of arteries under the subpubic concavity in their huge sample of three‐dimensional CT angiography findings.…”