Abstract
IntroductionWe studied the possible correlation between age, testosterone deficiency, cavernosal fibrosis and erectile dysfunction (ED).Methods47 patients with ED were enrolled between September 2010 and October 2011. IIEF-EF score, NPTR test using the Rigiscan method, total and free testosterone levels, and cavernosum biopsy were carried out on all patients. Patients aged 65 or over were defined as Old Age (OA) while patients under 65 were defined Young age (YA). The strength of the relationships found was estimated by Odds Ratio.Results74% of patients with values of over 52% collagen fibers in the corpora cavernosa were found to have organic ED. A significant difference was found in age, percentage of collagen fibers, testosterone levels between patients with Positive Rigiscan (PR) and Negative Rigiscan (NR). Hypotestosteronaemia increased the risk of ED with PR (OR: 21.4, 95% CI: 20.2-22.6) and in both young age patients (OR: 4.3, 95% CI: 2.4-6.2) and old age patients (OR: 15.5, 95% CI: 13.4-17.6). Moreover cavernosal fibrosis increased the risk of ED with PR in both young age patients (OR: 8.2, 95% CI: 6.4-10.0 and old age patients (OR: 24.6, 95% CI: 20.8-28.4).ConclusionsThis study demonstrates a strong association among age, testosterone deficiency, cavernosal fibrosis and ED with PR. Age, testosterone deficiency and cavernosal fibrosis are potentially correctable factors of cavernosal fibrosis and organic ED. Further, prospective studies are needed to evaluate if testosterone treatment, alone or in association with PDE5 inhibitors, may lower the risk of cavernosal fibrosis or decrease the severity the fibrosis in ED patients.
Highlights
We studied the possible correlation between age, testosterone deficiency, cavernosal fibrosis and erectile dysfunction (ED)
Normal erectile function was defined with the recording of at least one erection (70 out of 100% tip rigidity lasting for at least 10 min during either night) [8]: we considered Negative Rigiscan (NR) patients who had an erectile event of at least 70% rigidity recorded on the tip of the penis, which lasted for 10 minutes or more, and Positive Rigiscan (PR) remaining patients (Table 1)
As we can see in the group of patients with PR there is the presence of a higher percentage of collagen fibers, with a concomitant decrease of smooth muscle cells
Summary
We studied the possible correlation between age, testosterone deficiency, cavernosal fibrosis and erectile dysfunction (ED). In the animal model testosterone suppression lead to corpora cavernosum atrophy with concomitant structural alterations of the dorsal nerve of the penis, endothelial alterations, reduction of the smooth muscle component and increase in the deposition of extracellular matrix and cavernosal fibrosis. Androgens, acting on the haemostasis in the corpora cavernosa, regulate the growth of smooth muscle and protein synthesis of the connective tissue of the corpora cavernosa and a decrease in their production could give rise to the switch from elastic fibers to collagen fibers, which is the basis of cavernosal fibrosis [2,3]. Studies in hypogonadal patients have shown that testosterone replacement results in significant increase in brain activity in response to sexual stimulation, to levels similar to those seen in men with normal testosterone. As age advances the gonadal steroid hormones and, in particular, testosterone production decreases [5], nerve conduction slows and the efficiency of the vascular microcirculation of the penis is reduced
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