Utility of Dynamic MRA in the Evaluation of Male Erectile Dysfunction - Beyond the Abstract

Erectile dysfunction (ED) in younger men and in men with life-long erectile dysfunction negatively affects one’s confidence, leads to withdrawal from sexual activities, and is associated with lower quality of life and satisfaction with sexual activities. Binary classification of erectile dysfunction into organic (vasculogenic, neurogenic, and endocrine dysfunction) and psychogenic is often based on the age of the patient with many physicians erroneously assuming that younger men without clear risk factors for endothelial dysfunction must suffer from psychogenic ED. However, the majority of the young men with ED in this study had suffered from ED from adolescence, suggesting that factors other than just performance anxiety may contribute to ED in younger men.

The identification of vascular shunting during penile Doppler ultrasound in almost all patients with life-long ED led the senior authors to develop dynamic penile magnetic resonance imaging and angiogram (dpMRIA) to better delineate and understand the penile vascular anatomy.

To exclude false positive findings, we designed a protocol where the patient’s erection is sustained during the imaging study. Our current report shows a high level of concordance between penile ultrasound findings and dpMRIA; however, and more importantly, we showed that dpMRIA allows for objective visualization of penile vascular anatomy and dynamic assessment of the blood flow in and out of the penis. We noticed staggering variability in penile vascular anatomy from what has traditionally been described in anatomy textbooks. Our findings and methods allowed us to develop an optimized surgical technique to remedy visualized vascular anomalies and ameliorate erectile dysfunction in men who had failed to respond to other treatment methods. The importance of our technique lies not only in the ability to establish a diagnosis of ED but also in the ability for 4D reconstruction critical in surgical management of complex genitourinary anomalies. And while long-term results of such intervention are pending, dpMRIA potentially offers a way to stratify those patients that might benefit from surgery and those that might not.
Written by: Alexandra Roudenko, MD, Rand N Wilcox Vanden Berg, MD, Christopher Song, MD, Martin R Prince, MD, PhD, Darius A Paduch, MD, PhD, Daniel Margolis, MD

Department of Radiology, Mount Sinai Health System, New York, NY, USA., Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, NY, USA., Department of Radiology, Weill Cornell Medicine, New York, NY, USA., Arthur Smith Institute for Urology, Northwell Health, Great Neck, NY, USA.