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CASE REPORT
A young man with position-dependent erectile dysfunction: diagnostic work-up and interventional therapy of an arteriovenous malformation
Johannes HuberI,
Corresponding author
, Hans H SchildII, Christian G HuberIII, Peter HallscheidtIV, Markus HohenfellnerI
I Department of Urology, University of Heidelberg, Germany.
II Department of Radiology, University of Bonn, Germany.
III Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Germany.
IV Department of Radiology, University of Heidelberg, Germany.
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">With a prevalence of 5-20&#37;&#44; erectile dysfunction &#40;ED&#41; is a very common disease compromising quality of life of the patient and his partner alike&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> ED is mostly of multifactorial origin and principally psychogenic and organic causes can be discerned&#46; Main risk factors are age&#44; cardiovascular disease&#44; smoking&#44; depression and diabetes mellitus&#46; Therefore&#44; ED might indicate an early manifestation of general disorders and should thus be an inherent part in raising a medical history&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">CASE REPORT</span><p id="para20" class="elsevierStylePara elsevierViewall">In May 2006&#44; a 37-year-old man presented in our outpatient clinic with light ED that had prevailed since puberty&#46; Penetration was possible only in a standing position&#44; generally reaching nearly full erection&#46; Lowering the upper part of the body caused the erection to become weaker and sexual intercourse was hardly possible&#46; Self-administered phosphodiesterase type 5 inhibitors did not show any effect on the position dependence&#46; The patient was distressed by this situation&#46;</p><p id="para30" class="elsevierStylePara elsevierViewall">In other respects&#44; he was healthy and there was no evidence of psychosomatic etiology&#46; The only abnormal finding in routine diagnostic investigation for ED consisted of congenital penoscrotal cavernous hemangioma &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1a</a>&#41;&#46; As a vascular cause of the symptom was suspected&#44; we performed MRI angiography after intracavernosal application of 10 &#956;g alprostadil &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1b</a>&#41;&#58; a substantial arteriovenous malformation showed symmetrical draining towards the internal iliac veins&#46; As a result&#44; the penile arteries appeared rarefied&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="para40" class="elsevierStylePara elsevierViewall">A surgical approach was judged not promising and too risky&#46; Therefore&#44; we recommended selective percutaneous retrograde venoocclusive therapy&#44;<a class="elsevierStyleCrossRef" href="#bib2">2</a> which was performed successfully in two sessions &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1c</a>&#41;&#46; We assessed the International Index of Erectile Function &#40;IIEF&#41;<a class="elsevierStyleCrossRef" href="#bib3">3</a> and found a score of 18 at baseline&#44; 21 at 3-months&#39; follow-up and 18 at 24-months&#39; follow-up &#40;no ED at IIEF score &#62;21&#41;&#46; To objectify the functional changes we measured penis rigidity using RigiScan Plus&#174; at baseline and 3-months&#39; follow-up&#58;<a class="elsevierStyleCrossRef" href="#bib4">4</a> after intracavernosal application of 10 &#956;g alprostadil and achieving maximal erection&#44; data were acquired continuously while the patient alternated between standing and lying positions with a minimum episode duration of 5 minutes&#46; As rigidity on the penile tip has proved to be the best overall predictor of erectile dysfunction&#44;<a class="elsevierStyleCrossRef" href="#bib4">4</a> we used this parameter as our main outcome criterion&#46; Values for all useable lying and standing intervals were compared by applying a paired samples t-test &#40;<a class="elsevierStyleCrossRef" href="#fig2">Figure 2</a>&#41;&#59; p&#60;0&#46;05 was considered significant&#46; At baseline&#44; mean tip rigidity values differed significantly &#40;p &#61; 0&#46;038&#41; while at 3-months&#39; follow-up differences were no longer significant &#40;p &#61; 0&#46;676&#41;&#46; Although observed differences were small and there were no data on long-term test-retest reliability for Rigiscan&#174; measurements&#44; these results are consistent with the patient&#39;s subjective view&#46; Rigidity had improved&#44; especially in the distal part of the penis and was less dependent on body position&#46; At 24-months&#39; follow-up&#44; the patient rated therapeutic success to be very satisfying&#44; although the IIEF score had returned to the baseline score of 18&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">DISCUSSION</span><p id="para50" class="elsevierStylePara elsevierViewall">We describe the diagnostic work-up and treatment outcome in a young patient with position-dependent ED due to an arteriovenous malformation&#46; Hemangiomas are rarely found in the genitourinary tract<a class="elsevierStyleCrossRefs" href="#bib5">5&#8211;12</a> and cause ED in only a few cases&#44; dependent on their hemodynamic properties&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> In this case&#44; the congenital arteriovenous malformation drains arterious inflow directly to the internal iliac veins&#46; Therefore&#44; part of the arterial blood supply bypasses the corpora cavernosa and leads to a special form of venous leakage&#46; However&#44; the extent of the venous leakage and hence the erection rigidity depend on the intra-abdominal pressure&#44; which alters with body position&#46; For objectifying this anamnestic information and monitoring treatment outcome the Rigiscan&#174; device proved helpful&#46; It is one of the diagnostic measures recommended when cases remain ambiguous after basic investigation&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a></p><p id="para60" class="elsevierStylePara elsevierViewall">Vascular conditions are the most common organic cause of ED&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a> The vast majority of cases in this group result from metabolic changes&#44; increasing with age owing to cardiovascular disease and diabetes mellitus&#46; By far less common&#44; but more important in younger men with ED are macroscopic arterial or venous pathologies&#44; because once diagnosed&#44; some of them can be treated causally&#46; Patients with a history of pelvic or perineal trauma causing arteriogenic ED can benefit from vascular surgery with a 60-70&#37; long-term success rate&#46;<a class="elsevierStyleCrossRefs" href="#bib14">14&#44;15</a> However&#44; the results are entirely different concerning surgery for venous leakage&#46; The various types of venous resection show discouraging long-term results and have therefore been abandoned in general&#46;<a class="elsevierStyleCrossRef" href="#bib14">14</a> Only very occasionally&#44; more durable improvements have been reported in highly selected patients&#46;<a class="elsevierStyleCrossRef" href="#bib16">16</a> Because surgical treatment outcomes are limited&#44; minimal invasive approaches like percutaneous embolization seem justified&#46; This holds especially true as otherwise a penile prosthesis is the final option&#46;<a class="elsevierStyleCrossRef" href="#bib17">17</a> After interventional venoablative treatment initial response rates are around 70-80&#37;&#44; while lasting treatment success is found in &#60;30&#37;&#46; The latter is mainly due to venous collateralisation&#46;<a class="elsevierStyleCrossRefs" href="#bib2">2&#44;18&#44;19</a></p><p id="para70" class="elsevierStylePara elsevierViewall">Limited long-term success has also been found in the reported case&#46; Nevertheless&#44; the subjective view of ED is not necessarily linked to objective measurements and our patient still feels satisfied&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ethics committee approval&#58;</span> We performed all actions according to the &#8220;Declaration of Helsinki&#8221; in its latest version and respected usual data protection requirements&#46; Ethics committee approval was not needed because the routine treatment of an individual patient is described&#46; The patient is aware of the planned publication of his case&#46; He agreed and documented his decision by signing a consent form after reading the manuscript including figures&#46;</p></span></span>"
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            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The international index of erectile function &#40;IIEF&#41;&#58; a multidimensional scale for assessment of erectile dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              RC Rosen \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              A Riley \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              G Wagner \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              IH Osterloh \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              J Kirkpatrick \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              A Mishra \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0090-4295(97)00238-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Urology"
                        "fecha" => "1997"
                        "volumen" => "49"
                        "paginaInicial" => "822"
                        "paginaFinal" => "830"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9187685"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0090-4295(97)00238-0"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0090-4295&#40;97&#41;00238-0"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The correlation between the new RigiScan plus software and the final diagnosis in the evaluation of erectile dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              AE Benet \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Rehman \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RG Holcomb \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Melman \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "1996"
                        "volumen" => "156"
                        "paginaInicial" => "1947"
                        "paginaFinal" => "1950"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8911362"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0022-5347&#40;01&#41;65401-6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Giant penile cavernous hemangioma with intrapelvic extension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              M Froehner \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              P Tsatalpas \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              MP Wirth \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0090-4295(98)00444-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Urology"
                        "fecha" => "1999"
                        "volumen" => "53"
                        "paginaInicial" => "414"
                        "paginaFinal" => "415"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9933067"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0090-4295(98)00444-0"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0090-4295&#40;98&#41;00444-0"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Megapenis associated to corpus spongiosum agenesis with scrotal and pelvic hemangiomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              Y Nouira \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              I Kbaier \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              F Attyaoui \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              E Menif \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Horchani \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1159/000049838"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2001"
                        "volumen" => "40"
                        "paginaInicial" => "571"
                        "paginaFinal" => "574"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11752868"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1159/000049838"
                      "WWW" => array:1 [
                        "link" => "10&#46;1159&#47;000049838"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intrascrotal hemangioma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              C-Y Lin \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G-H Sun \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D-S Yu \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              C-J Wu \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              H-I Chen \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              S-Y Chang \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1080/01485010290031565"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Androl"
                        "fecha" => "2002"
                        "volumen" => "48"
                        "paginaInicial" => "259"
                        "paginaFinal" => "265"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12137586"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1080/01485010290031565"
                      "WWW" => array:1 [
                        "link" => "10&#46;1080&#47;01485010290031565"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intratesticular arteriovenous malformation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              V Skiadas \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              A Antoniou \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              H Primetis \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              L Moulopoulos \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              L Vlahos \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11255-005-0916-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinical course&#44; ultrasound and MRI findings of an extremely rare lesion on a 7 year follow-up basis&#46; Int Urol Nephrol"
                        "fecha" => "2006"
                        "volumen" => "38"
                        "paginaInicial" => "119"
                        "paginaFinal" => "122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16502065"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cavernous hemangioma of the scrotum&#58; a rare benign genital tumor of childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              FA Ferrer \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              PH McKenna \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0022-5347(01)67582-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "1995"
                        "volumen" => "153"
                        "paginaInicial" => "1262"
                        "paginaFinal" => "1264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7869525"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0022-5347(01)67582-7"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0022-5347&#40;01&#41;67582-7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Large renal cavernous hemangioma with renal vein thrombosis&#58; case report and review of literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              X Zhao \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Zhang \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              Z Zhong \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              CJ Koh \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              HW Xie \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              BE Hardy \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Urology"
                        "fecha" => "2009"
                        "volumen" => "73"
                        "paginaInicial" => "443&#46; e1"
                        "paginaFinal" => "443&#46; e3"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;j&#46;urology&#46;2008&#46;02&#46;049"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cavernous hemangioma of scrotum and penile shaft"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              H Senoh \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              Y Ichikawa \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              A Okuyama \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              M Takaha \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              T Sonoda \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1159/000281225"
                      "Revista" => array:6 [
                        "tituloSerie" => "Urol Int"
                        "fecha" => "1986"
                        "volumen" => "41"
                        "paginaInicial" => "309"
                        "paginaFinal" => "311"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3538595"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1159/000281225"
                      "WWW" => array:1 [
                        "link" => "10&#46;1159&#47;000281225"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Haemangioma of the urinary tract&#58; review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              H Jahn \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              HM Nissen \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1464-410x.1991.tb15276.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Urol"
                        "fecha" => "1991"
                        "volumen" => "68"
                        "paginaInicial" => "113"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1884135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1111/j.1464-410x.1991.tb15276.x"
                      "WWW" => array:1 [
                        "link" => "10&#46;1111&#47;j&#46;1464-410X&#46;1991&#46;tb15276&#46;x"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of erectile dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              M Kubin \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Wagner \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              AR Fugl-Meyer \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1038/sj.ijir.3900949"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Impot Res"
                        "fecha" => "2003"
                        "volumen" => "15"
                        "paginaInicial" => "63"
                        "paginaFinal" => "71"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12605242"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1038/sj.ijir.3900949"
                      "WWW" => array:1 [
                        "link" => "10&#46;1038&#47;sj&#46;ijir&#46;3900949"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The place of surgery for vascular impotence in the third millennium"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              E Wespes \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              T Wildschutz \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              T Roumeguere \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              CC Schulman \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ju.0000086160.63566.11"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2003"
                        "volumen" => "170"
                        "paginaInicial" => "1284"
                        "paginaFinal" => "1286"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14501742"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/01.ju.0000086160.63566.11"
                      "WWW" => array:1 [
                        "link" => "10&#46;1097&#47;01&#46;ju&#46;0000086160&#46;63566&#46;11"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microvascular arterial bypass surgery&#58; long-term outcomes using validated instruments"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              R Munarriz \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Uberoi \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              G Fantini \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              D Martinez \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              C Lee \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/j.juro.2009.04.031"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Urol"
                        "fecha" => "2009"
                        "volumen" => "182"
                        "paginaInicial" => "643"
                        "paginaFinal" => "648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19539333"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/j.juro.2009.04.031"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;j&#46;juro&#46;2009&#46;04&#46;031"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
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                              NU Rahman \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RC Dean \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              R Carrion \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              D Bochinski \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              TF Lue \n
                              \t\t\t\t\t\t\t\t
                              """
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                        "paginaFinal" => "2066"
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                          0 => array:2 [
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                              S Elhanbly \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              R Schoor \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              M Elmogy \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              L Ross \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Hegazy \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              C Niederberger \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
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                        "paginaFinal" => "196"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
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                      "titulo" => "Effectiveness of platinum wire microcoils for venous occlusion&#58; a study on patients treated for venogenic impotence"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              HH Schild \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              P Mildenberger \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              W Kersjes \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/BF00195515"
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                        "tituloSerie" => "Cardiovasc Intervent Radiol"
                        "fecha" => "1994"
                        "volumen" => "17"
                        "paginaInicial" => "170"
                        "paginaFinal" => "172"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8087837"
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              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous embolization for erectile dysfunction due to venous leakage&#58; prognostic factors for a good therapeutic result"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
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                              M Fern&#225;ndez Arjona \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              R Oteros \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              M Zarca \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              J D&#237;az Fern&#225;ndez \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              I Cortes \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1159/000052552"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Urol"
                        "fecha" => "2001"
                        "volumen" => "39"
                        "paginaInicial" => "15"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11223691"
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                          ]
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                      ]
                    ]
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Article information
ISSN: 18075932
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos