The penile blood flow index in the assessment of patients with erectile dysfunction: importance of associated risk factors

Abstract

Objective: Diabetes mellitus and arterial hypertension are known risk factors as a vascular etiology of erectile dysfunction (ED). Doppler ultrasound is a non-invasive method for cavernous arteries assessment, which improves the diagnosis as well as the treatment for these patients. We evaluated the cavernous arteries of patients with erectile dysfunction through Doppler ultrasound using the penile blood flow index (PBFI). We also assessed compared index in patients with ED and diabetes mellitus and/or arterial hypertension with patients presenting ED without these risk factors. Design: Retrospective study. Materials/Methods: Two hundred and seventy patients with erectile dysfunction with a mean age of 52.22 ± 12.78 years had their cavernous arteries assessed by Doppler ultrasound. Patients were divided into two groups: Group 1 (G1); 169 patients with associated risk factors: 87 presented arterial hypertension, 40 had diabetes mellitus and 42 presented both arterial hypertension and diabetes mellitus. Group 2 (G2); 101 patients with no risk factors described in G1. The penile blood flow index was estimated by the changes of the diameter of the cavernous arteries and the respective rate of systolic peak following the injection of 70 mg of papaverine. The results were classified as arteriogenic erectile dysfunction (AED) and non arteriogenic erectile dysfunction (NAED), based on whether PBFI was lower or higher than 285 respectively. PBFI was compared within the different subgroups and analyzed using Student t test. Results: Mean ages in G1 and G2 were 54.44 ± 11.06 and 47.65 ± 14.8 years, respectively. AED was diagnosed in 75.92% of patients (205 out of 270); 82.24% of patients in G1 (139 out of 169) presented AED (39.64% had arterial hypertension, 20.11% diabetes mellitus, and 22,24% presented both conditions); and 64.35% of patients in G2 (65 out of 101) presented AED. Patients diagnosed with diabetes mellitus and arterial hypertension or only diabetes showed a higher prevalence of AED, (88.37% and 82.92%, respectively) compared to 76.13% in the hypertensive subjects. Mean PBFI for G1 was significantly higher (203.64) compared to G2 (234.51) (p = 0.009). Mean PBFI was significantly lower in patients with diabetes and hypertension compared to G2 patients (p = 0.001). Conclusions: Using PBFI, a parameter that associates systolic peak speed and cavernous artery dilatation, we could record a significant difference between the groups of patients with erectile dysfunction with and without risk factors. The results showed a larger variation for PBFI in patients with both diabetes and hypertension, suggesting more severe vascular alterations in these patients. Supported by: None.