PERFECT-LUTS: Endovascular Revascularization Shows Promise for Patients with ED, Lower Urinary Tract Symptoms

In patients with erectile dysfunction (ED) and lower urinary tract symptoms (LUTS), endovascular revascularization of obstructive pelvic arterial lesions may improve symptoms, according to research presented at TCT 2014.

sun.wang.headFor PERFECT-LUTS, Tzung-Dau Wang, MD, PhD, of the National Taiwan University Hospital, Taipei City, Taiwan, and colleagues examined 48 patients with both ED and LUTS who underwent angioplasty of pelvic arterial lesions between July 2013 and March 2014.

Primary feasibility endpoints were changes in the International Prostate Symptom Score (IPSS) and its quality-of-life component and the International Index of Erectile Function-5 (IIEF-5) through 3 months. The primary safety endpoint was any major adverse events within 1 month, and clinical success was defined as a change of IPSS and IIEF-5 from baseline by at least three and four points, respectively, or IIEF-5 of 22 points or greater, indicating no dysfunction.

Patients had an average of two lesions each. Most were located in either the penile (39%), distal internal pudendal (28%) or proximal internal pudendal (15%) arteries. Three-month outcomes demonstrated improvements in both ED and LUTS in the overall cohort (see Figure).

While patients with lesions in the proximal internal pudendal artery or higher had marked improvement in LUTS, those with lesions in the distal internal pudendal artery or lower did not (P<.001 for interaction). No differential effects based on lesion location were noted for ED.

sun.wang.figureLimitations of the study, Wang noted, were small sample size, no control arm, no assessment of objective urinary flow and absence of complete CT angiography follow-up results.

“Our finding suggests that, in addition to benign prostatic hyperplasia, bladder ischemia is another important, treatable but under-recognized cause for LUTS,” he concluded.

After the session, Deepak L. Bhatt, MD, MPH, of Brigham and Women’s Hospital, Boston, inquired whether the researchers thought to use nocturnal penile tumescence testing in order to provide a more objective evaluation of the therapy’s effect. Wang said although they did not perform this test, they did collect Doppler ultrasound data, but the correlation between the ultrasound and the angiographic flow status is currently only about 60%.

A randomized trial would be the next step in testing endovascular revascularization for these lesions and symptoms, Wang observed, but the best strategy for long-term durability — stenting, drug-eluting balloon or balloon angioplasty — remains unclear.

Average patient age was 62.3 years, and average IPSS, IPSS-QoL and IIEF-5 scores were 13.4, 3.3 and 8.9, respectively. The majority of patients (65%) had CAD.

  

 

 

Disclosures:

 

  • Wang reports off-label use of coronary stents in the internal pudendal arteries.

 

 

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