Diabetes‐related research at the European Association of Urology Annual Congress

Abstract

More than one in three men being assessed for erectile dysfunction (ED) have diabetes, warns a study reported at the recent European Association of Urology Annual Congress (26–29 March, Milan). The study of 771 men consulting for ED over a two-year period at a German hospital showed that 35% had diabetes, including eight patients previously undiagnosed. Other cardiovascular risk factors were also common. Nearly one-third (31%) had arterial hypertension, with 12 men not previously known to have this problem. Twenty-one percent had dyslipidaemia and 14% had coronary disease. The researchers, from Segeberger Kliniken Norderstedt, Norderstedt-Hamburg, Germany, said: ‘Erectile dysfunction is intertwined with the metabolic syndrome and diabetes.’ They added: ‘ED is a portal into men's health. Rational treatment includes treating the underlying manifestations of metabolic syndrome.’ A second study evaluated 255 Korean men with coronary artery disease who were undergoing coronary angiography for erectile function using the International Index of Erectile Function (IIEF). Results reported at the Congress showed that 19.6% of the men had diabetes, and this had a negative impact on erectile function (p<0.05), as did older age and smoking. Further research demonstrated that an easy-to-use, four-point scale for ED, the Erection Hardness Scale (EHS), provides a reliable measure of erection hardness and an indicator of other health and well-being outcomes in patients with ED. The new scale rates the hardness of erection on a scale of one to four, with four being the maximal score. The language used is simple and direct, so that men with ED can use the scale to assess the severity of their condition and to monitor the impact of treatment. A score of one indicates that the penis is larger than normal but not hard, two means the penis is hard but not hard enough for penetration, three means the penis is hard enough for penetration but not completely hard, and four indicates that the penis is completely hard and fully rigid. A new study, SCORE 4 (Scoring Correspondence in Outcomes Related Erectile Dysfunction Treatment on a 4-point Scale), compared ratings on the EHS with other scales commonly used in clinical trials of ED, including the IIEF. It included 209 men (mean age 52 years) diagnosed with ED who were randomised to sildenafil or placebo, followed by an open-label extension period with flexible-dose sildenafil (50mg or 100mg). The results showed a nearly linear relationship between EHS ratings and results from other scoring systems. The relationship between the discrete points of the EHS and scores on components of other rating scales, including the IIEF, showed the close correspondence between erection hardness and erectile function, satisfaction with the quality of an erection, the overall sexual experience and emotional well-being in men with ED. Professor Herman van Ahlen, Professor of Urology, Klinikum Osnabrück, Müüüünster University, Germany, said that the EHS provided a simple, effective tool that could be used in clinical practice for assessing patients with ED. He added: ‘The EHS measures more than just erection hardness. It can also provide an assessment of the other factors associated with this debilitating condition. A patient's satisfaction with erection hardness has the scope to predict satisfaction with other quality of life measures.’ He suggested treatment should be aiming for a score of four.