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Variations in the anatomical origin of the internal pudendal artery are associated with early onset of erectile dysfunction, according to a study reported in BJU International for March.

The study, conducted by Dr. Yasuo Kawanishi of Takamatsu Red Cross Hospital in Kagawa with colleagues there and elsewhere in Japan, involved 145 patients with repeated incomplete erectile response to intracavernosal injections with prostaglandin E1.

The investigators analyzed images of the internal iliac arteries in the patients obtained by three-dimensional computed tomographic angiography.

Dr. Kawanishi's team found arterial variations, which they classified into five types:

• Type 1, defined as normal or basic, in which the internal pudendal artery originates from the anterior trunk of the internal iliac artery between the linea terminalis and the major ischial notch;
  
  
• Type 2, in which the internal pudendal artery originates from the anterior trunk of the internal iliac artery at the level of the major ischial notch or more distally;
  
  
• Type 3, in which the internal pudendal artery originates directly from the internal iliac artery at a level proximal to the linea terminalis;
  
  
• Type 4, in which the internal pudendal artery originates together, or within 1 cm of, the superior and inferior gluteal artery; and
  
  
• Type 5, in which the penile blood supply is dependent on arteries other than the internal pudendal artery, for example, the obturator artery.

Type 1 anatomy, found in 53 per cent, was more common in patients who developed erectile dysfunction at an older age. Types 2, 3 and 4 were more common in patients with early-onset erectile dysfunction.

Compared with patients with type 1 anatomy bilaterally, those with any of the variations bilaterally had a significantly increased risk of early onset erectile dysfunction (p = 0.002), the researchers report.

"Congenital factors might contribute to the development of erectile dysfunction," Dr. Kawanishi and colleague conclude. "If a man has bilateral variation from the common type, he might develop erectile dysfunction approximately ten years earlier than those who are identical in every way except for their Type 1 internal pudendal artery arrangements."


Source: Reuters"