Abstract
BackgroundErectile dysfunction (ED) is common among ageing men because of associated underlying risk factors which are peculiar to this category of patients. Endothelial dysfunction and replacement of cavernosal smooth muscles by collagen fibres are common in older men, making them prone to ED. It is either vasogenic, neurogenic, hormonal, cavernosal or psychogenic in origin, but vasogenic causes are the commonest. This study was aimed at establishing vasogenic causes among patients being evaluated for ED using Doppler ultrasound as this category of ED is amenable to either medical and/or surgical treatment.MethodsThe study was conducted from July 2015 to January, 2017 at Federal Medical Centre Abuja. Nineteen consecutive patients with clinical diagnosis of erectile dysfunction were evaluated with Doppler ultrasound scan using a high-frequency linear array transducer. The penile scan was done before and after intracavernosal injection of 20 µg of Prostaglandin E1 (PGE1). B-mode scan of the penis was done prior to intracavernosal injection of PGE1, and the spectral waveforms as well as peak systolic velocity (PSV) of the CA were recorded at 5 min interval, from 5 to 50 min post-intracavernosal injection of PGE1, using angle of insoation ≤ 60°.ResultsThe age range of the patients was fifty to sixty-six years (mean: 57.4 ± 4.3 years), while the PSV of CA varied between 21.4 and 104.4 cm/s (mean: 46.2 ± 19.2) among the entire patients, between 21.4 and 22.3 cm/s (mean: 21.9 ± 0.7) among patients with arteriogenic ED, and between 25.0 and 74.9 cm/s (mean: 45.0 ± 15.5) among those with venogenic ED. Arteriogenic ED was found in two patients (10.6%), while venogenic ED was observed in seven patients, which constituted 36.8% of the entire research participants. None had Peyronie’s disease, penile fracture, penile tumour or mixed arteriogenic and venogenic ED.Conclusion47.4% of the patients had vasogenic ED and venogenic ED was more common than arterioegenic ED in the age range considered. This categorization of ED with Doppler study is imperative before initiating therapy as treatment protocol for vasogenic ED is aetiologic specific.
Highlights
Erectile dysfunction (ED) is common among ageing men because of associated underlying risk factors which are peculiar to this category of patients
4 Discussion Erectile dysfunction is prevalent in ageing men because they are often affected with several diseases that could negatively influence sexual function; this includes systemic hypertension, diabetes mellitus and obesity [1, 9] Some engage in polypharmacy for prostatic diseases, diabetes mellitus, systemic hypertension and psychosomatic illnesses with some of the drugs acting centrally and affecting sexual performance libido [9, 10]
Some studies have shown increased probability of erectile dysfunction from 40 years of age and peaks in men above 70 years [12, 13]. This is consistent with the observation of Aiyekomogbon et al [14] where they observed that peak systolic velocity (PSV) of cavernosal arteries (CAs) decreases with age and by extension, ED of vascular origin was observed to increase with age
Summary
Erectile dysfunction (ED) is common among ageing men because of associated underlying risk factors which are peculiar to this category of patients. Erectile dysfunction (ED) is consistent inability to maintain erectile turgidity required for normal sexual performance [1, 2] It could arise from neurogenic, vasogenic, ED is commoner in the older men when compared with the young because of the age-related risk factors such as systemic hypertension, diabetes mellitus, hyperlipidaemia and obesity which are more frequently seen among the aged population [1]. Induction of vascular smooth muscle by phenyllephrine is reduced in the cavernosum of those above 60 years which affects the expected expansion of cavernous sinusoids reduction in their compressive effects on the emissary veins against the tunica albuginea These changes result in venous leak and venogenic erectile dysfunction
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