For the first time in Pakistan, a small team of doctors has used "radiological intervention" to cure male impotence, or erectile dysfunction as it is described medically.
The 29-year-old patient, who will be identified as X in this report to protect his privacy, suffered from erectile dysfunction caused by a venous leak, a condition that leaves patients unable to maintain sufficient blood flow through the veins of the male reproductive organ.
Renowned interventional radiologist Dr Kashif Shazlee, who joined Dr Imran Ali to perform the procedure, says the condition had forced the patient to turn down marriage proposals, but after the venous leaks were repaired using a radiological procedure, he made a full recovery and was preparing to get married now.
Erectile dysfunction, commonly known as male impotence, is among several sexual health issues men face in Pakistan, but as sex is a taboo subject in the country most of them don't get proper guidance and instead of going to qualified doctors they end up seeking help from quacks.
This costs them not only money but their health in many cases because unproven medicines usually destroy the kidneys. Quacks have traditionally capitalised on this vulnerability and are more focused on advertising the issue and leading young men astray.
X was among the few lucky ones to escape the trap, but not before being led down a blind alley or two.
At Karachi's Ziauddin Hospital Dr Shazlee and Dr Ali prescribed him Endovascular Embolization of Peri Prostatic Venous Plexus.
Speaking to SAMAA Digital, Shazlee said male impotence is a major problem in Pakistani society, but it is often misdiagnosed and the wrong diagnosis leads to wrong treatment. There is a lot of misunderstanding and quackery involved, he said.
Common causes of male impotence
Shazlee says there are four common causes for male impotence.
The first is pretty natural. With ageing, the flow of blood in our veins tends to reduce.
However, some people experience this at an early age.
The reduced blood flow could also be a result of hormonal changes or an imbalance.
A third reason is linked to diabetes and high blood pressure which both reduce blood flow in veins or cause blood vessels to narrow.
The fourth and more prevalent reason, according to Dr Shazlee, is psychological. Some men experience performance anxiety. Between 80 and 90 percent of young people suffer from varying levels of a host of similar psychological problems, including depression, anxiety caused by difficult social and economic conditions in our society and stress.
These issues affect men's sexual performance, according to Dr Shazlee.
He says people work two or three jobs due to their poverty, and physical fatigue, inadequate rest, lack of exercise and poor food can cause male impotence.
What is a venous leak
Venous leak, the condition X suffered from, is not among the four causes listed above.
Explaining the condition, Shazlee said during an erection the blood enters the reproductive organ naturally and should stay there for a certain period of time.
A natural process largely stops the blood from flowing out towards the heart, and only a very small quantity is sent back.
However, in men experiencing a venous leak, the blood flows back from the penis at the same rate it enters it. This is called a venous leak and it makes it impossible for the patient to perform normally, says Dr Shazlee.
Most men with the problem fail to figure out a possible remedy or find a suitable health practitioner. They fall prey to the advertisements painted on walls by quacks — the 'mardana kamzori ka ilaj' ones.
"Venous leak is [also] a common issue among young men. It could be resolved using modern methods employed everywhere in the world," says Dr Shazlee.
How is venous leak treated?
"The first step is similar to cardiac angiography of the heart except that the angiography, in this case, is performed on the penis," said the doctor.
"The veins responsible for draining the penis prematurely are closed using a special glue or coil. When the veins are blocked, the blood out-flow slows down and the performance returns to normal. This process is known as Endovascular Embolization of Peri Prostatic Venous Plexus. The processor involves closing veins or varicoceles."
The procedure itself takes 40 minutes to one hour to complete.
However, it follows a careful diagnosis.
When X came to Ziauddin hospital he not only faced a physical condition but also experienced psychological issues.
He had gone to several places to seek medical help and had lost hope, almost giving up on the possibility of living a married life.
Dr Kashif Shazlee says some forms of erectile dysfunction are also treated by urologists but the venous leak can only be repaired by an interventional radiologist.
"They [the urologists] prescribe some tests that we also prescribe. In addtional we ask for a psychological examination to asertain if the cause is psychogenic. We also ask them to undergo hormonal evaluation to see if the hormones levels are normal," he said.
If everything is found normal, an doppler ultrasound is performed to confirm that the blood inflow is normal. Only a few major health institutes have the facility to perform this ultrasound.
In the presence of a normal blood inflow, normal hormonal balance, and in the absence of a psychogenic cause, a doctor may conclude that the patient suffers from a venous leak.
Shazlee says X was diagnosed with a venous leak and it was the first case in Pakistan in which male impotence was treated using radiological intervention.
He said the inventory for the procedure is imported from other countries but in the United State and Europe it costs a lot more money than a patient may pay in Pakistan.
The treatment is five times cheaper in Pakistan and the final calculation depends on the conditions of the patient. Some people have problems only with one vein, others have with both. The amount of specific glue and coil required can lead to varied estimates which may range between Rs400,000 and Rs700,000.
The recovery begins on the second or third day and the patient experiences positive nocturnal changes as the blood flow improve.