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      Successful management of cavernosal artery pseudoaneurysm using microcoil embolization

      case-report

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          Abstract

          Erectile dysfunction (ED) is a common condition among men and has several causes. Among men under the age of 40, pelvic or perineal trauma is the most common cause of ED. Pelvic or perineal trauma often results in arterial injury as the likely mechanism of ED. We present the case of a 14-year-old male diagnosed with a pseudoaneurysm causing arteriogenic ED secondary to blunt force trauma to the perineum. We successfully managed arteriogenic ED with superselective embolization using microcoils. We also conclude through a review of the literature that microcoil and Gelfoam yield similar outcomes. We believe that it is important for urologists to be familiar with the various treatment techniques used by interventional radiologists in order to properly manage post-traumatic arteriogenic ED.

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          Most cited references21

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          The multinational Men's Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population.

          The aims of the Men's Attitudes to Life Events and Sexuality (MALES) study were to identify prevalence of erectile dysfunction (ED) and related health issues in the general male population in Europe, North and South America, and to examine the attitudes and behavior of men in relation to these health issues. Phase I of the MALES study involved 27839 men aged 20-75 years who were interviewed in eight countries (United States, United Kingdom, Germany,France, Italy, Spain, Mexico, and Brazil) using a standardized questionnaire. Phase II of the MALES study involved 2912 men who were recruited from the sub-sample of Phase I MALES participants who reported ED together with additional men with ED recruited from other sources. Prevalence of ED and associated attitudes. The overall prevalence of ED in the MALES sample was 16%. ED prevalence varied markedly by country, however, from a high of 22%of men in the US reporting ED to a low of 10% in Spain. The prevalence of self-reported ED increased with increasing age. Men with co-morbid medical conditions and risk factors, including cardiovascular disease, hypertension, dyslipidemia,and depression all reported higher prevalence of ED. Men with ED also reported increased prevalence rates of these co-morbid conditions. MALES Phase II data indicated that among men who reported ED, 58% had actively sought medical attention for their condition; however, only 16% of men with ED were currently being treated with oral PDE-5 therapy. The MALES study confirms the high prevalence rates of ED and its association with co-morbid medical conditions, such as diabetes and depression, reported in other large-scale, epidemiological studies. Despite the advent of oral phosphodiesterase inhibitors, only 58% of ED sufferers consult a physician about their problem, and only 16% of men with self-reported ED maintain their use of oral therapy.
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            Superselective Arterial Embolization of Pseudoaneurysm and Arteriovenous Fistula Caused by Transurethral Resection of the Prostate

            Summary Background Pelvic vascular lesions such as pseudoaneurysms and arteriovenous fistulas associated with the internal pudendal artery are uncommon. The most common cause is traumas including those of iatrogenic origin. Surgical treatment is complicated due to location of the lesions and endovascular approach is usually the first choice among the treatment options. Case Report A 79-year-old patient was admitted with massive hematuria following transurethral resection of prostate for benign prostatic hyperplasia. Doppler US and angiography revealed a pseudoaneurysm and arteriovenous fistula originating from the right internal pudendal artery. It was successfully treated with coil embolization. Conclusions Arteriovenous fistulas and pseudoaneurysms concerning internal pudendal artery may occur as complications of prostate operations. Minimally invasive endovascular methods provide safe and efficient treatment and today should be considered as the first line of choice.
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              Erectile dysfunction in men under 40: etiology and treatment choice.

              We undertook a retrospective review of 100 impotent men under age 40 to determine the underlying etiologic factors in the group and to evaluate the role of surgery in their care. Although patients ranged in age from 18 to 40 (mean--32.2 years), the number of patients increased steadily with advancing years. The majority of patients (72) had vasculogenic impotence (arteriogenic--15, venogenic--46, mixed--11), followed by psychogenic (13), neurogenic (12) and other causes (4). The differential diagnosis did not correlate with age. Contributing factors were present in 76%, trauma and substance abuse being most common. Essentially equal numbers of patients were treated surgically (40) and with intracavernous injection of vasoactive agents (39). Considerably fewer had a vacuum constriction device (5), oral medication (5), psychotherapy (4), other therapy (4), and none (3). The majority of patients referred to our tertiary urologic practice for treatment of vasculogenic impotence were sent by other urologists. Although the referral source did not appear to influence the choice of treatment, it probably has accounted for the preponderance of vasculogenic impotence in this series.
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                Author and article information

                Journal
                Transl Androl Urol
                Transl Androl Urol
                TAU
                Translational Andrology and Urology
                AME Publishing Company
                2223-4691
                October 2017
                October 2017
                : 6
                : 5
                : 973-977
                Affiliations
                [1 ]Department of Urology, University of Miami Miller School of Medicine , Miami, FL, USA
                [2 ]Department of Interventional Radiology, University of Miami Miller School of Medicine , Miami, FL, USA
                Author notes
                Correspondence to: Ranjith Ramasamy, MD. Department of Urology, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB 1560, Miami, FL 33136, USA. Email: ramasamy@ 123456miami.edu .
                Article
                tau-06-05-973
                10.21037/tau.2017.08.16
                5673808
                3f30bed7-84e2-41b3-bb27-ffee168e2db0
                2017 Translational Andrology and Urology. All rights reserved.
                History
                : 05 August 2017
                : 24 August 2017
                Categories
                Case Report

                arteriogenic erectile dysfunction (arteriogenic ed),superselective embolization,post-traumatic erectile dysfunction

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