Role of Lp(a) in patients with erectile dysfunction undergoing angioplasty for symptomatic pelvic artery disease.

Background: Atherosclerotic disease of erection-related arteries is a major reason for erectile dysfunction (ED). Lp(a) has been implied in the pathophysiology of atherosclerosis in the coronary and lower limb arteries. Here, we investigated if Lp(a) plays a specific role in ED due with symptomatic pelvic artery atherosclerosis. Patients and methods: Out of 276 consecutive patients treated for ED with angioplasties on proximal (69%) and distal (31%, distal to Alcock channel) erection-related arteries, 236 patients (age: 62±10 years) of which Lp(a) values were available were retrospectively analyzed. Results: The baseline International Index of Erectile Function-15 (IIEF-15) score was 29±15 and significantly increased to 43±20 (increase: 14±21) after treatment at average follow up of 286±201 days. In 25%, Lp(a) values were elevated to more than 30 mg/dL. Hypercholesterolemia, coronary, lower extremity peripheral, and polyvascular disease were more common in patients with Lp(a) ≥60 mg/dl. Anatomic arterial lesion distribution (proximal/distal), improvement in IIEF-15 and clinically driven re-intervention rate (overall 7%) did not differ between patients with <30, 30-59, and ≥60 mg/dL Lp(a). Conclusions: While angioplasty is an effective therapy for ED of arterial origin in patients with obstruction of erection-related arteries, Lp(a) does not seem to play a major role for clinical outcomes in these patients.

Significance of detailed hematological parameters as markers of arteriogenic erectile dysfunction.

BACKGROUND: Several hematologic parameters have been shown to be strongly associated with cardiovascular disease, yet few studies were conducted to assess their relationship with atherogenic erectile dysfunction. OBJECTIVES: To find out the differences in hematological parameters between patients with atherogenic erectile dysfunction and healthy controls through as comprehensive a hematological examination as possible and try to assess and predict atherogenic erectile dysfunction using possible indicators. MATERIALS AND METHODS: We collected hematological parameters in detail from 105 healthy controls and 183 patients with erectile dysfunction (119 patients with atherogenic erectile dysfunction patients and 64 patients with venous erectile dysfunction) who were selected by nocturnal penile tumescence and rigidity and color duplex doppler ultrasound. RESULTS: Statistically significant differences were found between the atherogenic erectile dysfunction and venous erectile dysfunction groups in platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, and mean platelet volume (all p < 0.01). When comparing atherogenic erectile dysfunction with the healthy population, we found statistically significant differences between the two groups in white blood cell, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume, triglycerides, high-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol (neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, mean platelet volume, triglycerides, and high-density lipoprotein cholesterol, p < 0.01; white blood cell, p = 0.024; non-high-density lipoprotein cholesterol, p = 0.036). Receiver operator characteristic curve analysis showed that neutrophil to lymphocyte ratio and platelet to lymphocyte ratio had the highest diagnostic value (neutrophil to lymphocyte ratio: area under the curve = 0.810, p < 0.001, cut-off = 1.995; platelet to lymphocyte ratio: area under the curve = 0.782, p < 0.001, cut-off = 126.3). CONCLUSION: Several hematological parameters (white blood cell, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, mean platelet volume, triglycerides, high-density lipoprotein cholesterol, and non-high-density lipoprotein cholesterol) can be considered markers of atherogenic erectile dysfunction, while these parameters were not significantly different in venous erectile dysfunction compared to healthy subjects. This suggests that hematological examinations may be a convenient and effective method to help evaluate and diagnose atherogenic erectile dysfunction.

Prognostic Indicators for Successful Low-intensity Extracorporeal Shock Wave Therapy Treatment of Erectile Dysfunction.

OBJECTIVE: To assess prognostic factors affecting successful low-intensity extracorporeal shockwave therapy (Li-ESWT) treatment of erectile dysfunction (ED) in patients with vasculogenic ED and to report 30-month follow-up. METHODS: This study was conducted upon 425 patients with vasculogenic ED. Assessment of ED was done using Sexual Health Inventory for Men (SHIM) score. Patients were treated by Li-ESWT using PiezoWave2 (Richard Wolf) device. Successful Li-ESWT was defined as 6-month SHIM score of 22-25. Patients with successful treatment were followed for 30 months. RESULTS: Mean Baseline SHIM scores for the total population studied was 11.8 with a range from 5 to 20. After 6 months from treatment, 220 (51.8%) patients reported satisfactory sexual intercourse. Age, diabetes, hypertension, smoking, obesity, hyperlipidemia, pretreatment SHIM score, and the duration of ED were all found to be significant factors affecting the success of Li-ESWT. At 30-month follow-up, 168 (76.3%) patients from those who responded to Li-ESWT still reported satisfactory sexual intercourse with a SHIM score of 22-25 without using PDE5i. CONCLUSION: Li-ESWT is safe and effective treatment of ED with 30 months success in 39.5% of patients treated. Li-ESWT should be offered to patients with mild-to-moderate ED and not to those with severe ED.

Significance of blood lipid parameters as effective markers for arteriogenic erectile dysfunction.

OBJECTIVES: The aim of the study was to investigate the ability of the blood lipid parameters to predict the discrimination of arteriogenic erectile dysfunction (ED). MATERIALS AND METHODS: 260 subjects with ED and 60 healthy controls were enrolled. Eight lipid parameters, including total cholesterol (TC), triglycerides (TG), LDL-C, HDL-C, non-HDL-C, TC/HDL ratio, TG/HDL ratio, and LDL/HDL ratio, together with other plasma biomarkers like sex hormones were measured in all participants. Nocturnal penile tumescence (NPT), penile color Doppler ultrasonography (pDUS), and neurophysiological tests were conducted in the ED group. RESULTS: Forty-four ED patients with normal NPT, and 84 with normal vasculature or mixed vascular abnormalities were excluded. The remaining 132 men were classified into two groups, arteriogenic ED (n = 87) and venous leakage (n = 45), by pDUS. TC/HDL, LDL/HDL, and LDL-C were significantly higher (P < .05) and HDL-C was significantly lower (P < .05) in the arteriogenic ED group when compared with the venous and the control groups. Receiver operating characteristic curve analysis identified area under the curve values that were predictive of arteriogenic ED for: TC/HDL and LDL/HDL 0.720 and 0.737, TC/HDL ≥ 3.73 and LDL/HDL ≥ 2.01 (sensitivity: 56.3%; specificity: 83.3% vs sensitivity: 55.2%; specificity: 91.7%), HDL-C (0.791), ≤1.25 mmol/L (sensitivity: 69%; specificity: 81.7%), LDL-C (0.641), ≥2.41 mmol/L (sensitivity: 55.2%; specificity: 76.7%).In the arteriogenic ED group, a significant inverse correlation was detected between TC/HDL, LDL/HDL, LDL-C and 10-minutes peak systolic velocity (PSV) (All P < .01)and a significant positive correlation was recognized between HDL-C and 10-minutes PSV(P < .01). Multivariate step wise linear regression indicated lipid parameters of LDL/HDL and HDL-C were significantly associated with 10-MinPSV (P < .01). CONCLUSION: These findings suggest the LDL/HDL and HDL-C might be a powerful indicator to predict and diagnose arteriogenic ED, and lipid-lowing therapy should be considered for these patients.

Dynamic infusion cavernosometry and cavernosography for classifying venous erectile dysfunction and its significance for individual treatment.

BACKGROUND: The precise pathophysiology of venous erectile dysfunction (VED) was still unclear. Dynamic infusion cavernosometry and cavernosography (DICC) was the gold standard approach for the diagnoses of VED. However, a standard operative procedure of DICC was needed and it was unclear whether DICC could show promise in accurate assessment and treatment of VED. The aim of this study was to establish an optimized operation process of DICC and evaluate the efficacy of DICC in the diagnoses and therapy of VED. METHODS: One hundred and forty-seven VED patients identified by the color doppler duplex ultrasonography (CDDU) were included. Then the method of DICC was adopted to assess the severity of VED and all patients were divided into 4 groups, including (1) non-VED; (2) mild VED; (3) moderate VED and (4) severe VED. All patients received the treatment of psychotherapy. Drug therapy, the intervention embolism of corpus cavernosum and the implantation of penile prosthesis were applied if psychotherapy was ineffective for patients. The international index of erectile function (IIEF-5) scores of patients were collected and compared before and after treatment. RESULTS: IIEF-5 score of non-VED group after psychotherapy (19.35 ±â€Š3.59) and drug therapy (23.31 ±â€Š0.75) was higher than that before psychotherapy (15.30 ±â€Š2.72, t = -4.31, P < 0.01) and drug therapy (16.62 ±â€Š1.50, t = -19.13, P < 0.01). IIEF-5 scores of mild VED (18.25 ±â€Š2.60) and moderate VED group (14.83 ±â€Š4.17) after treatment was improved significantly by intervention embolism of corpus cavernosum when compared with those before treatment (mild: 15.50 ±â€Š2.14, t = -2.31, P < 0.05; moderate: 11.83 ±â€Š2.86, t = -1.45, P < 0.05). However, drug therapy and intervention embolism (IE) of corpus cavernosum showed poor effects on patients with moderate and severe VED patients (P > 0.05). IIEF-5 score of severe VED group was increased under the treatment of implantation of penile prosthesis (23.25 ±â€Š0.71) compared with that before treatment (8.00 ±â€Š0.39, t = -53.25, P < 0.05). CONCLUSION: DICC was a valid diagnostic tool that could identify patients with VED. And DICC had great effect on the diagnosis and individual therapy for patients with VED in varying degrees. Moreover, the manipulation of DICC needed uniform standards.

Erectile dysfunction links to cardiovascular disease-defining the clinical value.

Despite many advances over the last few decades, cardiovascular disease (CVD) remains the leading cause of death globally, with men afflicted at an earlier age than women. In a bid to reduce the global burden of morbidity and mortality due to CVD, emphasis has been placed on prevention, particularly on widespread promotion of ideal cardiovascular health behaviors and advancing strategies to identify and treat high-risk individuals who may benefit from aggressive preventive therapy. Erectile dysfunction is a highly prevalent condition that has been demonstrated to share the same risk factors as clinical CVD, and to have independent predictive value for future CVD events. Importantly, subclinical atherosclerosis appears to precede vascular ED by a decade or longer, with ED preceding clinical CVD such as myocardial infarction and stroke in temporal sequence by about 2-5 years. Crucially, since ED may represent the first presentation of otherwise "healthy" men to care providers, a clinical diagnosis of vascular ED may represent a unique opportunity to identify high risk individuals, intervene, and thus prevent progression to clinical CVD. This review summarizes up-to-date evidence of the relationship between ED and subclinical and clinical CVD, and details the position of current guidelines and clinical recommendations on the role of ED assessment in CVD prevention. Finally, this review proposes a clinical framework for the incorporation of ED into standard CVD risk assessment in middle-age men.

Penile doppler ultrasound predicts cardiovascular events in men with erectile dysfunction.

BACKGROUND: Traditional risk factors used to assess cardiovascular risk miss a significant population who are indeed at risk for future cardiac events. Erectile dysfunction (ED) is an emerging marker for future cardiovascular disease (CVD) and major adverse cardiovascular events (MACE), especially in young and middle-aged men with vasculogenic ED. Cavernous arteries morphological alterations at penile colour doppler ultrasound (P-CDU) are used to find a vasculogenic ED. OBJECTIVES: We investigated the possible relationship between cavernous arteries morphological alterations at P-CDU assessment and future MACE. MATERIALS AND METHODS: We conducted a retrospective cohort study involving 300 ED patients, aged 35-65 years (mean age 54.1 ± 7.1), with a follow-up period of 10 years. Patients underwent vascular evaluation including P-CDU, colour doppler ultrasound of the carotid and lower limbs arteries. At baseline data for glucose metabolism, lipid profile, hypertension and hormonal status were collected. During the follow-up period, the occurrence of MACE was evaluated. RESULTS: We found a strong association between cavernous arteries morphological alterations and CVD with a threefold increased risk of future MACE in comparison to patients with healthy cavernous arteries (RR 3.2, 95% CI 1.17-8.78). This association remained statistically significant after adjustment for CV risk factors (age, glycaemia, total cholesterol, hypertension and smoke). CONCLUSIONS: Morphological alterations of cavernous arteries are independently associated with an increased risk of future MACE. These data contribute to the formulation of the hypothesis that cavernous artery pathology at P-CDU is related to MACE.

[Selective internal pudendal arteriography in the diagnosis of arteriogenic erectile dysfunction].

OBJECTIVE: To explore the procedure of selective internal pudendal arteriography (IPA) and its application in the diagnosis of arteriogenic erectile dysfunction (AED). METHODS: We performed selective IPA for 62 patients highly suspected of AED with abnormal nocturnal penile tumescence (NPT) and peak systolic velocity (PSV) of the penile cavernosal artery < 25 ml/s. Using digital subtraction angiography, we assessed the stenosis of the main internal pudendal artery and measured the lengths of the dorsal penile arteries and cavernosal arteries. RESULTS: Of the total number of patients, 21 were found with normal internal pudendal arteries, dorsal penile arteries and cavernosal arteries, 7 with abnormal pudendal arteries and atherosclerotic lesions, 37 with inadequately visualized dorsal penile arteries and/or cavernosal arteries, and 3 with both abnormal pundendal and dorsal penile arteries or inadequately visualized cavernosal arteries. No complications were observed except for 3 cases of subcutaneous hematoma at the puncture site. CONCLUSIONS: Selective IPA can display the morphological features of internal pudendal, dorsal penile and cavernosal arteries and help to localize arterial lesions and evaluate blood supply in the penile artery. Therefore, it is a safe and reliable method for the diagnosis of AED.

Serum Arginase II level can be a novel indicator for erectile dysfunction in patients with vasculogenic erectile dysfunction: a comparative study.

PURPOSE: The purpose of the study was to compare serum level of Arginase II in patients with vasculogenic erectile dysfunction (ED) versus healthy controls and to assess if its level is affected by severity of ED. METHODS: This is a prospective study that compared Arginase II in 40 patients with ED versus 40 healthy controls. Patients were excluded if they had any pelvic trauma or pelvic surgery, hormonal disorders, Peyronie's disease, smoking, drug addiction or systemic illnesses. ED was evaluated by the validated Arabic version of the abbreviated five-item form of the international index of erectile function (IIEF-5). Serum arginase II level was assayed using ELIZA. Mann-Whitney, Kruskal-Wallis and Chi-square tests and Spearman correlation were used as appropriate and confirmed by logistic regression model. RESULTS: 22 (55%) patients had DM. 15 (37.5%), 7 (17%), 6 (15%) and 12 (30%) patients suffered from severe, moderate, mild to moderate and mild ED, respectively. The level of serum Arginase II was significantly higher in patients than controls (p < 0.001) and confirmed by multivariate logistic regression analysis. It also correlated significantly with age (r2 = 0.22; p < 0.001) and IIEF-5 score (r2 = 0.8; p < 0.001). Serum Arginase II increased significantly with more severe ED (p < 0.001). Arginase II was also significantly higher in diabetic patients (p < 0.001). CONCLUSION: Serum level of Arginase II is significantly higher in patients with vasculogenic ED compared to healthy controls. It correlates significantly with age and IIEF-5 and was significantly affected by the severity of ED.

Sexual Function Is an Indicator of Central Arterial Stiffness and Arterial Stiffness Gradient in Japanese Adult Men.

BACKGROUND: As arterial stiffness increases in the absence of subjective symptoms, a personal indicator that reflects increased risk of cardiovascular disease is necessary. Penile erection is regulated by vascular function, and atherosclerosis affects the penile artery earlier than it affects the coronary and carotid arteries. Therefore, we hypothesized that deterioration of erectile function could be a marker of increased risk for cardiovascular disease. To test our hypothesis, we assessed erectile function and arterial stiffness in a cross-sectional study. METHODS AND RESULTS: Carotid-femoral pulse wave velocity (PWV), brachial-ankle PWV, femoral-ankle PWV, and arterial stiffness gradient (PWV ratio: carotid-femoral PWV/femoral-ankle PWV) were measured as indexes of central, systemic, and peripheral arterial stiffness and peripheral organ damage, respectively, in 317 adult men. In addition, erectile function was assessed by using the questionnaire International Index of Erectile Function 5 (a descending score indicates worsening of erectile function). The scores of male sexual function were inversely correlated with carotid-femoral PWV (rs=-0.41), brachial-ankle PWV (rs=-0.35), femoral-ankle PWV (rs=-0.19), and PWV ratio (rs=-0.33). Furthermore, multivariate linear regression analyses revealed that International Index of Erectile Function 5 scores were significantly associated with carotid-femoral PWV (ß=-0.22) and PWV ratio (ß=-0.25), but not with brachial-ankle PWV and femoral-ankle PWV. CONCLUSIONS: Our results indicated that erectile function is independently associated with central arterial stiffness and peripheral organ damage. These findings suggest that male sexual function could be an easily identifiable and independent marker of increased central arterial stiffness and peripheral organ damage.

Levels of uric acid in erectile dysfunction of different aetiology.

Erectile dysfunction is a common disease characterized by endothelial dysfunction. The aetiology of ED is often multifactorial but evidence is being accumulated in favor of the proper function of the vascular endothelium that is essential to achieving and maintaining penile erection. Uric acid itself causes endothelial dysfunction via decreased nitric oxide production. This study aims to evaluate the serum uric acid (SUA) levels in 180 ED patients, diagnosed with the International Index of Erectile Function-5 (IIEF-5) and 30 non-ED control. Serum uric acid was analyzed with a commercially available kit using ModularEVO (Roche, Monza, Italy). Within-assay and between-assay variations were 3.0% and 6.0%, respectively. Out of the ED patients, 85 were classified as arteriogenic (A-ED) and 95 as non-arteriogenic (NA-ED) with penile-echo-color-Doppler. Uric acid levels (median and range in mg/dL) in A-ED patients (5.8, 4.3-7.5) were significantly higher (p < .001) than in NA-ED patients (4.4, 2.6-5.9) and in control group (4.6, 3.1-7.2). There was a significant difference (p < .001) between uric acid levels in patients with mild A-ED (IIEF-5 16-20) and severe/complete A-ED (IIEF-5 ≤ 10) that were 5.4 (range 4.3-6.5) mg/dL and 6.8 (range 6.4-7.2) mg/dL, respectively. There was no difference between the levels of uric acid in patients with different degree of NA-ED. Our findings reveal that SUA is a marker of ED but only of ED of arteriogenic aetiology.

Erectile dysfunction - overview from a cardiovascular perspective.

Erectile dysfunction (ED) is an evolving health problem with growing incidence in the ageing male population with potentially predictive value for cardiovascular and other chronic diseases. ED shares the common cardiovascular risk factors. The aetiology of ED is numerous including neurogenic, psychogenic, arteriogenic, and venogenic reasons. The origin of arteriogenic ED is frequently atherosclerosis. Patients not adequately responding to conservative measures including oral medication are often referred to further vascular diagnostics and therapy. At present, the refinements in endovascular therapy allow for minimal-invasive revascularization of erection-related arteries. The role of endovascular therapy in the complex framework of the multifactorial causes of ED requires further scientific scrutiny.

Clinical and Imaging Outcomes up to 1 Year Following Balloon Angioplasty for Isolated Penile Artery Stenoses in Patients With Erectile Dysfunction: The PERFECT-2 Study.

PURPOSE: To assess the angiographic and clinical outcomes in patients with erectile dysfunction and isolated penile artery stenoses treated by balloon angioplasty. METHODS: In this prospective study, 22 patients (mean age 61.0±7.6 years, range 50-79) with erectile dysfunction and 34 isolated penile artery stenoses (mean 74.9%±9.1%) were enrolled and underwent balloon angioplasty. The mean International Index for Erectile Function-5 (IIEF-5) score at baseline was 10.3±4.5. The mean lesion length was 11.1±9.0 mm (mean reference vessel diameter 1.7±0.4 mm). The primary endpoint was in-segment restenosis ≥50% by pelvic computed tomography angiography (CTA) at 8 months. The 1-year sustained clinical success (IIEF-5 score ≥22 or a ≥4-point change in the IIEF-5 score and no later decline by ≥4) was the secondary outcome measure. RESULTS: Procedural success was achieved in 31 (91%) of 34 stenotic lesions; there was 1 flow-limiting dissection and 2 arteries with >30% residual stenosis. At 8 months, 14 of 34 lesions in 13 of 22 patients had CTA-documented binary restenosis. At 1 year, sustained clinical success was achieved in 11 of 22 patients. Of the 9 patients not developing binary restenosis, 8 achieved sustained clinical success. CONCLUSION: Our findings establish the safety and efficacy of penile artery angioplasty for patients with erectile dysfunction and isolated penile artery stenoses. They also highlight the unmet need for a more enduring treatment strategy for penile artery stenotic disease.

Novel Evidence-Based Classification of Cavernous Venous Occlusive Disease.

PURPOSE: The primary aim of our study was to determine whether an evidence-based rationale could categorize cavernous venous occlusive disease into mild, moderate and severe erectile dysfunction. MATERIALS AND METHODS: A total of 863 patients underwent color duplex Doppler ultrasound from January 2010 to June 2013 performed by a single urologist. We identified a cohort of 75 patients (8.7%) with a diagnosis of cavernous venous occlusive disease based on a unilateral resistive index less than 0.9, and right and left peak systolic velocity 35 cm per second or less after visual sexual stimulation. At a median followup of 13 months patients were evaluated for treatment efficacy. RESULTS: A total of 75 patients with a median age of 60 years (range 19 to 83) and a mean body mass index of 26.3 kg/m(2) (range 19.0 to 39.3) satisfied the criteria of cavernous venous occlusive disease. When substratified into tertiles, resistive index cutoffs were obtained, including mild cavernous venous occlusive disease-81.6 to 94.0, moderate disease-72.6 to 81.5 and severe disease-59.5 to 72.5. Using these 3 groups the phosphodiesterase type 5-inhibitor failure rate (p = 0.017) and SHIM (Sexual Health Inventory for Men) score categories (1 to 10 vs 11 to 20, p = 0.030) were statistically significantly different for mild, moderate and severe cavernous venous occlusive disease. Treatment satisfaction was also statistically significantly different. Penile prosthetic placement was a more common outcome among patients with erectile dysfunction and more severe cavernous venous occlusive disease. CONCLUSIONS: Our retrospective analysis supports a correlation between the phosphodiesterase type 5 inhibitor failure rate, SHIM score and the rate of surgical intervention using resistive index values. Our data further suggest that an evidence-based classification of cavernous venous occlusive disease by color Doppler ultrasound is possible and can triage patients to penile prosthetic placement.

Erectile dysfunction as a predictor of advanced vascular age.

Vascular age (VA) represents chronological age (CA) adjusted for individual's atherosclerotic burden. The presence of erectile dysfunction (ED) has been considered as a clinical sentinel of premature atherosclerosis. The objective of this study was to explore the predictive value of ED in assessing the discrepancy between VA and CA. In the period from 1 January 2014 to 1 January 2015, all consecutive men referring to the outpatient departments of the Clinics of Urology and Cardiology in Belgrade (Serbia) were considered for enrolment in this cross-sectional study. General exclusion criteria were: age below 18, heart failure, history of myocardial infarction, impaired renal and liver function, acute infection, history of endocrine disease other than type 2 diabetes, pelvic surgery or trauma, and acute coronary syndrome within the last 6 months. According to the presence of ED, hypertension, type 2 diabetes and history of coronary artery disease participants were assigned into five study groups. Hierarchical multiple regression analysis was conducted to identify the predictive value of ED in detection of advanced VA. The mean age of males enrolled in the study was 52.9 ± 7.7 years. The predominance of VA over CA was statistically significantly higher in the group of participants with coexistence of ED and hypertension compared to the group of patients with ED and type 2 diabetes (p = 0.027) and the group of patients with ED (p = 0.014) and control group (p < 0.01). Regression analysis highlighted that ED represented a highly important marker (p < 0.01) of advanced VA, which independently accounted for 6.1% of the variance in the discrepancy between VA and CA. Our study suggests that assessment of ED could be a part of a more comprehensive prediction of patients' advanced VA. Screening among such a highly selected population may help identify those that would most benefit from drug treatments and life style changes.

Failure to attain stretched penile length after intracavernosal injection of a vasodilator agent is predictive of veno-occlusive dysfunction on penile duplex Doppler ultrasonography.

Penile duplex Doppler ultrasound (PDDU) assesses the etiology of erectile dysfunction. Peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) are common PDDU parameters. We assessed whether stretched penile length (SPL) in the flaccid state and measured penile length at peak erection after intracavernosal injection (ICI) of a vasodilator during PDDU correlated with the etiology of erectile dysfunction. We performed a retrospective review of 93 patients who underwent PDDU for erectile dysfunction. Normal and stretched penile length were measured, both at a flaccid state prior to ICI and at peak erection during PDDU. Collected data included patient demographics, vascular, and anatomic parameters. The mean age was 52 years. SPL was equivalent to peak penile length after ICI in 60 patients (65%, group 1) and did not match in 33 (35%, group 2). There were no significant differences between the two groups in terms of flaccid, stretched, and post-ICI erect penile lengths, IIEF score, PSV, percent rigidity or tumescence, and vasodilator dose used. Patients in group 2 had less of a change in penile length from flaccid to erect state (36% vs. 44%, p = 0.02), higher EDV (12.0 vs. 8.5, p = 0.041), lower RI (0.6 vs. 1.0, p = 0.046), and more veno-occlusive dysfunction (82% vs. 53%, p = 0.001). On multivariate analysis, failure to reach maximum SPL at peak ICI erection (OR 2.255, CI 1.191-4.271, p = 0.0126), EDV (OR 1.281, CI 1.115-1.471, p < 0.001) and RI (OR 0.694, CI 0.573-0.723, p = 0.009) predicted veno-occlusive dysfunction. Failure to reach maximal SPL during PDDU using ICI with a vasodilator agent predicted veno-occlusive dysfunction, which is independent of both penile rigidity and tumescence. This measurement could serve as another diagnostic tool for predicting veno-occlusive dysfunction when PDDU is not readily available. Limitations include the subjective nature of penile measurements and different PGE1 doses used.

[Dynamic infusion cavernosometry and cavernosography for the diagnosis and classification of venous erectile dysfunction].

OBJECTIVE: To explore the procedures of dynamic infusion cavernosometry and cavernosography (DICC) and their application in the diagnosis and classification of venous erectile dysfunction (VED). METHODS: This study included 103 ED patients, aged 20 to 43 years, highly suspected of VED, with disease courses of 4 months to 6 years. DICC was performed and analyses were made on the results, especially the parameters of flow-to-maintain (FTM) and pressure decay (PD) in the corpus cavernosum. RESULTS: Based on the parameters of FTM and PD, 21 of the patients were normal, 5 were suspected of VED, 39 had mild VED, 25 had moderate VED, and 13 had severe VED. Penile subcutaneous hematoma was found in 4 of the patients, all recovered after 3 to 5 days, with no other complications. CONCLUSION: DICC is a reliable, safe and minimally invasive method for the diagnosis and classification of VED.

Venous leakage treatment revisited: pelvic venoablation using aethoxysclerol under air block technique and Valsalva maneuver.

OBJECTIVE: We evaluated the effectiveness of pelvic vein embolization with aethoxysclerol in aero-block technique for the treatment of impotence due to venous leakage in men using sildenafil for intercourse. The aim of the procedure was to reduce the use of sildenafil. METHODS: A total of 96 patients with veno-occlusive dysfunction, severe enough for the need of PDE5 inhibitors for vaginal penetration, underwent pelvic venoablation with aethoxysclerol. The mean patient age was 53.5 years. Venous leaks were identified by Color Doppler Ultrasound after intracavernous alprostadil injection. Under local anesthesia a 20-gauge needle was inserted into the deep dorsal penile vein. The pelvic venogram was obtained through deep dorsal venography. Aethoxysclerol 3% as sclerosing agent was injected after air-block under Valsalva manoeuver. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Additionally, a pre- and post- therapy IIEF score and a digital overnight spontaneous erections protocol (OSEP) with the NEVA™-system was performed. RESULTS: At 3 month follow-up 77 out of 96 patients (80.21%) reported to have erections sufficient for vaginal insertion without the use of any drug or additional device. Four (4.17%) patients did not report any improvement. Follow up with color Doppler ultrasound revealed a new or persistent venous leakage in 8 (8.33%) of the patients. No serious complications occurred. CONCLUSIONS: Our new pelvic venoablation technique using aethoxysclerol in air-block technique was effective, minimally invasive, and cost-effective. All patients were able to perform sexual intercourse without the previously used dosage of PDE5 inhibitor. This new method may help in patients with contra-indications against PDE5 inhibitors, in patients who cannot afford the frequent usage of expensive oral medication or those who do not fully respond to PDE5-inhibitors.

Evaluation of young men with organic erectile dysfunction.

Erectile dysfunction (ED) in men under the age of 40 was once thought to be entirely psychogenic. Over the last few decades, advances in our understanding of erectile physiology and improvements in diagnostic testing have restructured our understanding of ED and its etiologies. Although psychogenic ED is more prevalent in the younger population, at least 15%-20% of these men have an organic etiology. Organic ED has been shown to be a predictor of increased future morbidity and mortality. As such, a thorough work-up should be employed for any man with complaints of sexual dysfunction. Oftentimes a treatment plan can be formulated after a focused history, physical exam and basic lab-work are conducted. However, in certain complex cases, more testing can be employed. The major organic etiologies can be subdivided into vascular, neurologic, and endocrine. Specific testing should be directed by clinical clues noted during the preliminary evaluation. These tests vary in degree of invasiveness, precision, and at times may not affect treatment. Results should be integrated into the overall clinical picture to assist in diagnosis and help guide therapy.