Transluminal angioplasty in the treatment of arteriogenic impotence.

Factors bearing on the role of transluminal angioplasty in the management of arteriogenic impotence are considered. Our clinical experience indicates that arteriogenic impotence is frequent, either alone or combined with venogenic impotence. High quality diagnostic angiographic studies and their accurate interpretation are the prime requirements for proper patient selection. Numerous arteriographic adjuncts are required: vasodilation with intracavernosal injection of a papaverine-phentolamine mixture, selective internal pudendal injections, direct magnification, nonionic contrast agents, and tailored radiographic projections. Venogenic impotence must be excluded by cavernosometry and cavernosography. In impotent patients with bilateral leg and hip claudication, dilatation of common or internal iliac stenoses should benefit many cases with pure arteriogenic impotence. In the absence of claudication, angioplasty will be most frequently indicated for distal internal pudendal lesions, using 2-3 mm balloon-catheter systems. Stenoses of intrapenile branches, while common, must await further technological developments before they too may become amenable to transluminal recanalization. Unilateral transluminal angioplasty, when technically successful, should prove clinically successful when patients have been properly selected. Transluminal angioplasty can reduce the cost and morbidity of penile revascularization and may assume a modest role in the treatment of arteriogenic impotence.