Vascular Disorders
The vascular disorders that affect urological function primarily involve vascular insufficiency leading to erectile dysfunction of vascular origin, the most common cause of erectile dysfunction in adult men.
Vascular erectile dysfunction is not merely a sexual problem. It is often the first clinical manifestation of underlying atherosclerosis and an increased risk of cardiovascular disease.
It may affect men of any age, although its prevalence rises markedly over time, particularly in the presence of cardiovascular risk factors such as diabetes, hypertension, hyperlipidaemia and smoking.
Its effects extend beyond erectile function. Vascular insufficiency may significantly affect quality of life, self-confidence and psychological well-being.
Characteristics of Vascular Erectile Dysfunction
Vascular erectile dysfunction results from an inadequate blood supply to the corpora cavernosa of the penis, primarily because of endothelial dysfunction and atherosclerotic changes in the pelvic or pudendal arteries.
At molecular level, reduced production of nitric oxide (NO) by the endothelium is the central mechanism. NO is the principal mediator of vasodilation within the erectile tissues. Without sufficient NO, the blood vessels cannot dilate adequately to produce and maintain an erection.
Factors that aggravate endothelial dysfunction, including increased oxidative stress, chronic inflammation and hyperglycaemia, contribute to the progressive deterioration of erectile function.
Addressing these underlying biological mechanisms, rather than relying exclusively on symptomatic treatment with phosphodiesterase type 5 (PDE5) inhibitors, represents a rational therapeutic objective.
Scientific Basis
Clinical studies evaluating hyperbaric oxygen therapy in vascular erectile dysfunction have reported improvements in erectile function scores, including the International Index of Erectile Function (IIEF), increased penile blood flow measured by Doppler ultrasound and improved endothelial function.
In patients who had not responded adequately to pharmacological treatment with PDE5 inhibitors, hyperbaric oxygen therapy was associated with a significant additional benefit.
The proposed mechanism of action directly targets endothelial function. Increased oxygenation supports NO synthesis by endothelial cells, reduces the oxidative stress that degrades NO before it can act and stimulates neovascularisation within the erectile tissue, thereby improving the vascular network over the longer term.
The Role of Hyperbaric Oxygen Therapy
In vascular erectile dysfunction, hyperbaric oxygen therapy may be used as an adjunctive option, particularly in patients with a documented vascular cause, those with an incomplete response to pharmacological treatment or those seeking an alternative to long-term medication. It does not replace the management of underlying cardiovascular risk factors.
The treatment aims to support biological restoration of vascular function by increasing NO synthesis to improve vasodilation, reducing the oxidative stress that impairs endothelial function and stimulating neovascularisation to strengthen the vascular network within the erectile tissue.
The effects are not immediate, but they may represent a meaningful and longer-lasting biological improvement.
A typical treatment course consists of 20 to 30 sessions, planned in collaboration with the urologist or andrologist.