##common.pageHeaderLogo.altText##

Original article

Vol. 149 No. 4950 (2019)

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

  • Jan Schönhofen
  • Vignes Mohan
  • Martin C. Schumacher
  • Markus Bechir
  • Hak H. Keo
  • Heinz Schönhofen
  • Thomas Joder
  • Curt Diehm
  • Christoph Kalka
  • Nicolas Diehm
Cite this as:
Swiss Med Wkly. 2019;149:w20154
Published
04.12.2019

Summary

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. Eighty-five 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.

References

  1. Castro RP, Hernández PC, Casilda RR, García JR, Tapia MJR. Epidemiología de la disfunción eréctil. Factores de riesgo [Epidemiology of erectile dysfunction. Risk factors]. Arch Esp Urol. 2010;63(8):637–9. Article in Spanish.
  2. Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54–61. doi:.https://doi.org/10.1016/S0022-5347(17)34871-1
  3. Aytaç IA, McKinlay JB, Krane RJ. The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences. BJU Int. 1999;84(1):50–6. doi:.https://doi.org/10.1046/j.1464-410x.1999.00142.x
  4. Grover SA, Lowensteyn I, Kaouache M, Marchand S, Coupal L, DeCarolis E, et al. The prevalence of erectile dysfunction in the primary care setting: importance of risk factors for diabetes and vascular disease. Arch Intern Med. 2006;166(2):213–9. doi:.https://doi.org/10.1001/archinte.166.2.213
  5. Gandaglia G, Briganti A, Montorsi P, Mottrie A, Salonia A, Montorsi F. Diagnostic and Therapeutic Implications of Erectile Dysfunction in Patients with Cardiovascular Disease. Eur Urol. 2016;70(2):219–22. doi:.https://doi.org/10.1016/j.eururo.2016.01.054
  6. Caretta N, De Rocco Ponce M, Minicuci N, Palego P, Valente U, Garolla A, et al. Penile doppler ultrasound predicts cardiovascular events in men with erectile dysfunction. Andrology. 2019;7(1):82–7. doi:.https://doi.org/10.1111/andr.12561
  7. Diehm N, Borm AK, Keo HH, Wyler S. Interdisciplinary options for diagnosis and treatment of organic erectile dysfunction. Swiss Med Wkly. 2015;145:w14268. doi:.https://doi.org/10.4414/smw.2015.14268
  8. Diehm N, Marggi S, Ueki Y, Schumacher D, Keo HH, Regli C, et al. Endovascular Therapy for Erectile Dysfunction-Who Benefits Most? Insights From a Single-Center Experience. J Endovasc Ther. 2019;26(2):181–90. doi:.https://doi.org/10.1177/1526602819829903
  9. Rogers JH, Goldstein I, Kandzari DE, Köhler TS, Stinis CT, Wagner PJ, et al. Zotarolimus-eluting peripheral stents for the treatment of erectile dysfunction in subjects with suboptimal response to phosphodiesterase-5 inhibitors. J Am Coll Cardiol. 2012;60(25):2618–27. doi:.https://doi.org/10.1016/j.jacc.2012.08.1016
  10. Doppalapudi S, Shukla P, Kolber M, Singh M, Fischman A, Rastinehad A. Endovascular therapy for vasculogenic erectile dysfunction: a systematic review of arterial and venous therapies. J Vasc Interv Radiol. 2019;30(8):1251–1258.e2. doi:. https://doi.org/10.1016/j.jvir.2019.01.024
  11. Baumann F, Hehli D, Makaloski V, Schumacher M, Schönhofen H, Diehm N. Erectile dysfunction - overview from a cardiovascular perspective. Vasa. 2017;46(5):347–53. doi:.https://doi.org/10.1024/0301-1526/a000627
  12. Wang TD, Lee WJ, Yang SC, Lin PC, Tai HC, Hsieh JT, et al. Safety and six-month durability of angioplasty for isolated penile artery stenoses in patients with erectile dysfunction: a first-in-man study. EuroIntervention. 2014;10(1):147–56. doi:.https://doi.org/10.4244/EIJV10I1A23
  13. Altinkilic B, Hauck EW, Weidner W. Evaluation of penile perfusion by color-coded duplex sonography in the management of erectile dysfunction. World J Urol. 2004;22(5):361–4. doi:.https://doi.org/10.1007/s00345-004-0423-y
  14. Hoppe H, Studer R, Kessler TM, Vock P, Studer UE, Thoeny HC. Alternate or additional findings to stone disease on unenhanced computerized tomography for acute flank pain can impact management. J Urol. 2006;175(5):1725–30, discussion 1730. doi:.https://doi.org/10.1016/S0022-5347(05)00987-0
  15. Feldman HA, Johannes CB, Derby CA, Kleinman KP, Mohr BA, Araujo AB, et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med. 2000;30(4):328–38. doi:.https://doi.org/10.1006/pmed.2000.0643
  16. Mulhall JP, Luo X, Zou KH, Stecher V, Galaznik A. Relationship between age and erectile dysfunction diagnosis or treatment using real-world observational data in the USA. Int J Clin Pract. 2016;70(12):1012–8. doi:.https://doi.org/10.1111/ijcp.12908
  17. Munden RF, Carter BW, Chiles C, MacMahon H, Black WC, Ko JP, et al. Managing Incidental Findings on Thoracic CT: Mediastinal and Cardiovascular Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2018;15(8):1087–96. doi:.https://doi.org/10.1016/j.jacr.2018.04.029
  18. Uddin SMI, Mirbolouk M, Dardari Z, Feldman DI, Cainzos-Achirica M, DeFilippis AP, et al. Erectile dysfunction as an independent predictor of future cardiovascular events: The multi-ethnic study of atherosclerosis. Circulation. 2018;138(5):540–2. doi:. https://doi.org/10.1161/CIRCULATIONAHA.118.033990
  19. Allen MS, Walter EE. Erectile Dysfunction: An Umbrella Review of Meta-Analyses of Risk-Factors, Treatment, and Prevalence Outcomes. J Sex Med. 2019;16(4):531–41. doi:.https://doi.org/10.1016/j.jsxm.2019.01.314
  20. Dong JY, Zhang YH, Qin LQ. Erectile dysfunction and risk of cardiovascular disease: meta-analysis of prospective cohort studies. J Am Coll Cardiol. 2011;58(13):1378–85. doi:.https://doi.org/10.1016/j.jacc.2011.06.024
  21. Regnier P, Lareyre F, Hassen-Khodja R, Durand M, Touma J, Raffort J. Sexual Dysfunction After Abdominal Aortic Aneurysm Surgical Repair: Current Knowledge and Future Directions. Eur J Vasc Endovasc Surg. 2018;55(2):267–80. doi:.https://doi.org/10.1016/j.ejvs.2017.11.028
  22. Majd P, Ahmad W, Luebke T, Gawenda M, Brunkwall J. Impairment of erectile function after elective repair of abdominal aortic aneurysm. Vascular. 2016;24(1):37–43. doi:.https://doi.org/10.1177/1708538115577290
  23. Ballard JL, Abou-Zamzam AM, Jr, Teruya TH, Harward TRS, Flanigan DP. Retroperitoneal aortic aneurysm repair: long-term follow-up regarding wound complications and erectile dysfunction. Ann Vasc Surg. 2006;20(2):195–9. doi:.https://doi.org/10.1007/s10016-006-9014-2
  24. Lederle FA, Johnson GR, Wilson SE, Acher CW, Ballard DJ, Littooy FN, et al.; Aneurysm Detection and Management Veterans Affairs Cooperative Study. Quality of life, impotence, and activity level in a randomized trial of immediate repair versus surveillance of small abdominal aortic aneurysm. J Vasc Surg. 2003;38(4):745–52. doi:.https://doi.org/10.1016/S0741-5214(03)00423-3
  25. Unno N, Inuzuka K, Yamamoto N, Sagara D, Suzuki M, Konno H. Preservation of pelvic circulation with hypogastric artery bypass in endovascular repair of abdominal aortic aneurysm with bilateral iliac artery aneurysms. J Vasc Surg. 2006;44(6):1170–5. doi:.https://doi.org/10.1016/j.jvs.2006.08.011
  26. Koo V, Lau L, McKinley A, Blair P, Hood J. Pilot study of sexual dysfunction following abdominal aortic aneurysm surgery. J Sex Med. 2007;4(4 Pt 2):1147–52. doi:.https://doi.org/10.1111/j.1743-6109.2006.00343.x
  27. Lee ES, Kor DJ, Kuskowski MA, Santilli SM. Incidence of erectile dysfunction after open abdominal aortic aneurysm repair. Ann Vasc Surg. 2000;14(1):13–9. doi:.https://doi.org/10.1007/s100169910003
  28. Resorlu M, Arslan M, Karatag O, Adam G. Thorax Computed Tomography Findings in Patients with Erectile Dysfunction. J Clin Imaging Sci. 2017;7:25. doi:.https://doi.org/10.4103/jcis.JCIS_32_17
  29. Chung SD, Kang JH, Liao CH, Chiu KM, Lin HC. Increased risk for cancer following erectile dysfunction: a nationwide population-based follow-up study. J Sex Med. 2011;8(5):1513–20. doi:.https://doi.org/10.1111/j.1743-6109.2010.02076.x
  30. Hasanain AFA, Mahdy RE, Mahran AMA, Safwat ASM, Mohamed AO, Abdel-Aal SM. Erectile dysfunction in patients with nonalcoholic fatty liver disease. Arab J Gastroenterol. 2017;18(1):21–4. doi:.https://doi.org/10.1016/j.ajg.2017.02.002
  31. Weizman AV, Nguyen GC. Diverticular disease: epidemiology and management. Can J Gastroenterol. 2011;25(7):385–9. doi:.https://doi.org/10.1155/2011/795241
  32. Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. Aging Male. 2019;22(1):12–9. doi:.https://doi.org/10.1080/13685538.2018.1434772
  33. Kardasevic A, Milicevic S. The Correlation Between Prostate Volume in Patients with Benign Prostatic Hyperplasia in Relation to Erectile Dysfunction. Med Arch. 2016;70(6):449–52. doi:.https://doi.org/10.5455/medarh.2016.70.449-452
  34. Kardasevic A, Milicevic S. Correlation of Subjective Symptoms in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction. Med Arch. 2017;71(1):32–6. doi:.https://doi.org/10.5455/medarh.2017.71.32-36
  35. Prabhakar AM, Le TQ, Abujudeh HH, Raja AS. Incidental findings and recommendations are common on ED CT angiography to evaluate for aortic dissection. Am J Emerg Med. 2015;33(11):1639–41. doi:.https://doi.org/10.1016/j.ajem.2015.07.078
  36. Millor M, Bartolomé P, Pons MJ, Bastarrika G, Beloqui Ó, Cano D, et al. Whole-body computed tomography: a new point of view in a hospital check-up unit? Our experience in 6516 patients. Radiol Med (Torino). 2019; Epub ahead of print. doi:.https://doi.org/10.1007/s11547-019-01068-y
  37. Hinton J, Gough S, Ahmed H, Gabara L, Rawlins J, Calver A, et al. Frequency and impact of incidental findings on computed tomography during work-up for transcatheter aortic valve implantation: single centre experience and review of the literature. Br J Radiol. 2019;92(1102):20190344. doi:.https://doi.org/10.1259/bjr.20190344
  38. Karius P, Lembcke A, Sokolowski FC, Gandara IDP, Rodríguez A, Hamm B, et al. Extracardiac findings on coronary computed tomography angiography in patients without significant coronary artery disease. Eur Radiol. 2019;29(4):1714–23. doi:.https://doi.org/10.1007/s00330-018-5688-4
  39. Nourzaie R, Das J, Abbas H, Thulasidasan N, Gkoutzios P, Ilyas S, et al. Extravascular findings during upper limb computed tomographic angiography focusing on undiagnosed malignancy. World J Radiol. 2019;11(1):10–8. doi:.https://doi.org/10.4329/wjr.v11.i1.10
  40. Kay FU, Canan A, Abbara S. Common Incidental Findings on Cardiac CT: a Systematic Review. Curr Cardiovasc Imaging Rep. 2019;12(6):21. doi:.https://doi.org/10.1007/s12410-019-9494-4