📖 Pudendal angioplasty: what is it?
Arteriogenic erectile dysfunction is caused by an insufficient blood supply to the corpora cavernosa, due to a stenosis (narrowing) or occlusion of the internal pudendal artery or its branches (penile and cavernous arteries). It is distinguished from venous leak by specific Doppler ultrasound findings: a low peak systolic velocity (< 25–30 cm/s) without venous reflux.
Pudendal angioplasty is an endovascular treatment that dilates the arterial stenosis with a balloon and, if necessary, places a stent to keep the artery open. It improves the blood supply to the perineum and can restore or improve erectile function. It is performed under local anaesthesia through the femoral artery, as a day case.
🎯 Indications
- Arteriogenic erectile dysfunction confirmed by penile Doppler ultrasound (PSV < 25–30 cm/s)
- Stenosis of the internal iliac or pudendal artery documented by MR angiography or CT angiography
- Failure of PDE5 inhibitors (Viagra®, Cialis®) in the setting of a vascular cause
- Vascular risk factors: diabetes, hypertension, dyslipidaemia, smoking, history of pelvic or pelvi-perineal surgery
- After a full andrological assessment and a psychological evaluation if needed
🔧 Technique
📊 Pre-procedure work-up
Dynamic penile Doppler ultrasound (after intracavernous PGE1 injection). MR angiography or CT angiography of the pelvis to map the stenosis. IIEF-5 score.
🩸 Percutaneous angioplasty
Retrograde catheterisation of the internal iliac artery and the pudendal artery via the right femoral route. Balloon angioplasty ± stenting of the stenosis. Final angiographic check.
🏠 Aftercare
Day case. Monitoring for 2–4 hours after the procedure. Antiplatelet drugs (aspirin ± clopidogrel) after the procedure according to protocol. Clinical evaluation and Doppler ultrasound at 3 months.
📈 Results
Improvement of the IIEF score in 50–65% of cases at 12 months in published studies. Better results with a tight, focal documented stenosis. PDE5 inhibitors also become more effective.
✅ What are the expected benefits?
- Improvement of the IIEF score in 50 to 65% of cases at 12 months for well-selected focal stenoses
- Causal treatment of the arterial stenosis, targeting the vascular mechanism directly
- Day case, under local anaesthesia, with no incision
- May improve the effectiveness of PDE5 inhibitor treatment taken in parallel
- Can be repeated in case of restenosis
🩹 What are the possible complications?
| Complication | Description | Frequency |
|---|---|---|
| Haematoma at the femoral puncture site | Resolves spontaneously | 2–5% |
| Restenosis | A further angioplasty remains possible | 20–30% at 1 year |
| No improvement | Alternatives to be discussed (PDE5 inhibitors, injections, prosthesis) | 35–50% |
📐 What are the limitations of the treatment?
Improvement is not guaranteed (50-65% of patients respond), and restenosis is possible (20-30% at 1 year), in which case a further angioplasty can be considered. Associated non-arterial causes (venous, hormonal, psychogenic) are not treated by this technique. In all cases, the other treatment options remain available.
🔀 What are the other possible techniques and alternatives?
💊 PDE5 inhibitors
First-line treatment, which may be continued in combination.
💉 Intracavernous injections
Effective regardless of the vascular cause, but the injection must be repeated before each sexual intercourse.
🔧 Penile prosthesis
A last-resort solution when other treatments have failed.
🚭 Managing risk factors
Stopping smoking and controlling diabetes and blood pressure to limit the progression of atherosclerosis.
❔ What happens if I finally decline the treatment?
You remain entirely free in your decision. Your doctor will discuss the alternatives with you: PDE5 inhibitors, intracavernous injections, penile prosthesis, or management of vascular risk factors.
❓ Frequently asked questions
How can I tell whether my erectile dysfunction is of arterial origin?
Does pudendal angioplasty work in all patients?
Can this treatment be combined with a drug such as Viagra?
🔗 Related pages
🔗 See also
Quick answer
Pudendal angioplasty treats erectile dysfunction of arterial origin by dilating narrowed pudendal arteries, through a puncture at the wrist or groin, under local anaesthesia, without surgery. It is intended for men in whom a vascular work-up (penile Doppler ultrasound or CT angiography) confirms an accessible arterial stenosis.
📚 Data from the literature
This review reports the results of the PERFECT registry (Taiwan): clinical improvement in more than 60% of patients one year after pelvic angioplasty, with a restenosis rate of 30 to 40% in the distal segments of the pudendal and penile arteries.
✓ Why this page is trustworthy
Written by the Interventional Radiology team at Cochin Hospital AP-HP, Université Paris Cité. Medically reviewed by an interventional radiologist of the department. Last updated: July 2026.