1173 ETIOLOGIC EVALUATION OF ERECTILE DYSFUNCTION IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME

Abstract

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20131173 ETIOLOGIC EVALUATION OF ERECTILE DYSFUNCTION IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME Gregory Lieser and Daniel Shoskes Gregory LieserGregory Lieser Cleveland, OH More articles by this author and Daniel ShoskesDaniel Shoskes Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.810AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A high proportion of men with Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), also known as NIH category III prostatitis, complain of erectile dysfunction (ED). The etiology of ED in these patients is not known. We present a cohort of patients with ED and CP/CPPS evaluated with hormonal, endothelial and vascular hemodynamic tests and correlated these findings with their symptom severity and disease phenotype. METHODS A cohort of patients with both ED and CP/CPPS who completed full ED evaluation was identified from our MenÆs Health Registry. None had ED prior to developing CP/CPPS. The CP/CPPS phenotype was determined clinically using the UPOINT system. International Index of Erectile Function (IIEF) and NIH Chronic Prostatitis Symptom Index (CPSI) scores assessed symptom severity. Patients had color penile Doppler with pharmacologic erection, Endopat measurement of peripheral arterial tone (PAT) plus free and total serum testosterone. RESULTS A total of 10 patients met all criteria, with a mean age of 32.9 (range 19-43). There was no correlation between severity of ED or CPPS symptoms by IIEF (mean 32 +/− 8.7) and CPSI (mean 20.9 +/− 4.2) scores. One patient had a marginally low total testosterone (260 ng/dl, mean of group 478). Three patients had abnormal PAT (suggesting early systemic arterial disease). Four patients had abnormal penile hemodynamics: 3 with decreased arterial flow (peak systolic velocity < 30 cm/s), 1 with veno-occlusive disease (end diastolic velocity > 5 cm/s) and 1 patient with both arterial and venous disease. In this young cohort, age did not correlate with vascular findings. Interestingly, both patients with veno-occlusive disease were positive for the pelvic floor Tenderness domain in their UPOINT phenotype and all 3 patients with decreased arterial penile blood flow were positive for both Tenderness and Psychosocial (depression or catastrophizing) domains (p=0.03 by Fisher Exact test). CONCLUSIONS Most young men who develop ED as a complication of CP/CPPS have normal hormonal and hemodynamic testing, suggesting a psychogenic cause related to pain and/or stress. There is however a smaller but potentially significant group with abnormal hemodynamics that may point to increased cardiac risk. This association between abnormal hemodynamics and pelvic floor spasm may suggest an etiologic link and could support the benefit of pelvic floor physical therapy for ED in those CP/CPPS patients positive for the “Tö” domain in their UPOINT phenotype. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e479 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Lieser Cleveland, OH More articles by this author Daniel Shoskes Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...