Clinical Diagnosis Of Erectile Dysfunction Research Articles

(523) Changes in Testosterone Levels in Patients with Erectile Function

Abstract Introduction Erectile dysfunction (ED) is a disease that affects approximately 20% of adult men. Androgen deficiency is one of the organic etiologies described for this sexual dysfunction. Objective To estimate the frequency of alterations in the sex hormone binding globuline (SHBG), total testosterone (TT), calculated free (FT) and bioavailable testosterone (BT) in Spanish men with a clinical diagnosis of erectile dysfunction in Madrid, Spain. Patients and methods Cross-sectional study. Men over 18 years of age with a clinical diagnosis of erectile dysfunction and a score in the international index of erectile function (IIEF-EF) < 26 were included. Serum levels of SHBG, TT, TL and TB were evaluated and the proportion of men was estimated. with hormonal alterations defined as: a) serum levels <2.49 ng/mL of TT in men under 50 years and <1.93 ng/mL in men of 50 years or older; b) TL for calculated value <2% of total testosterone; c) TB for calculated value <40% of total testosterone; d) serum SHBG levels >54.1 nmol/L in men younger than 50 years and >76.7 nmol/L in men 50 years and older. Results 30 subjects participated in the study. The mean age was 50.6 years (+/− 13.2), the median scores for IIEF-EF, Erection Hardness Score (EHS) and Aging Male Symptoms Score (AMS) were 15 (range 1-24), 2 (range 1-3) and 29.5 (range 11-62) respectively. 6 patients (20%) had severe erectile dysfunction, 13 (43.3%) moderate, 8 (26.7%) mild to moderate, and 3 (10%) mild erectile dysfunction. The mean TT was 4.94 ng/mL (+/− 1.91), FT 1.94% (+/− 0.605), BT 45.6% (+/− 14.2), and SHBG 33.3 nmol/L ( +/− 14.5). Only 6.7% of the patients (n=2) presented alterations of the TT, while in 60% (n=18) an alteration of the FT was found, in 36.7% (n=11) an alteration of the BT and in 3.3% (n=1) SHBG alterations, alterations being more frequent in men with moderate ED. Conclusions Our study found alterations in total testosterone in a small percentage of patients with ED, however the alterations in Free Testosterone calculated turned out to be much higher. This study suggests that future research should be carried out to identify a relationship between changes in calculated free testosterone levels and the presence of erectile dysfunction. Disclosure No

Evaluation of erectile dysfunction in the ageing men using colour Doppler sonography

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.

Effects of "metabolic memory" on erectile function in diabetic men: A retrospective case-control study.

This study was performed to explore the effects of metabolic memory on diabetic erectile dysfunction (ED), especially the severity and response to treatment. Through medical records and follow-up by telephone, 67 patients meeting the criteria with a clinical diagnosis of ED and a diabetic history of more than 5years were enrolled for erectile function analysis. They were divided into a glycemic control group, a glycemic non-control group and a metabolic memory group according to glycemic levels and treatments for diabetes in the past 5years, and they were treated with phosphodiesterase type 5 (PDE5) inhibitors for 4weeks. Erectile function and efficacy were assessed by the International Index for Erectile Function (IIEF), the Erection Hardness Score (EHS), and the Sexual Encounter Profile (SEP). The patients in the glycemic control group performed better in erectile function than those in the other groups. The patients in the glycemic control group received a significantly greater score on both the EHS and the five domains of the IIEF than did the patients in the glycemic non-control group and the metabolic memory group (all P<.001). There were also statistically significant differences favoring the glycemic control group (P<.05) in SEP2 and SEP3 success rates. However, there were no significant differences between the metabolic memory group and the glycemic non-control group in these erectile function assessments (P>.05). Significant negative correlations were seen between HbA1c levels at the time of consultation and the scores on the IIEF-EF and the EHS (Pearson r-values of -0.338 with P=.005 and -0.273 with P=.025, respectively). HbA1c levels at the first diagnosis of diabetes mellitus (DM) were also significantly negatively correlated with scores on the IIEF-EF and the EHS with greater Pearson correlation coefficients (Pearson r-values of -0.478 with P<.001 and -0.392 with P=.001, respectively). Significant improvements on each of the erectile function assessments were observed among diabetic patients with ED, but no significant difference in efficacy was observed between each group. The phenomenon of metabolic memory did have a significant influence on ED in men with diabetes, associated with the severity of ED but not the response to medical treatment. Early hyperglycemia exposure would have long-term disadvantageous effects on erectile function in diabetic patients with ED, which would be sustained even after the patients achieve better glycemic control. In this report, we looked at the erectile functions of 67 patients with a clinical diagnosis of ED and a diabetic history of more than 5years. We found that early hyperglycemia exposure would have long-term disadvantageous effects on erectile function in diabetic patients with ED, which would be sustained even after the patients achieve better glycemic control. We further found that the effects were associated with the severity of ED but not the response to medical treatment in men with diabetes.

Diagnostic categorization of erectile dysfunction using duplex color doppler ultrasonography and significance of phentolamine redosing in abolishing false diagnosis of venous leak impotence: A single center experience.

Background and Aims:Erectile dysfunction (ED) is an inability to achieve and maintain erectile rigidity sufficient for satisfactory sexual performance. It is either organic or psychogenic in origin. This study was aimed at establishing vasculogenic causes among patients being evaluated for ED using Penile Doppler Ultrasound.Methods:Fifty-two consecutive patients with the clinical diagnosis of ED were evaluated with color Doppler ultrasound scan using a 7.5 MHz high-frequency linear transducer between July 2016 and June 2019. The examination was commenced 3 min after an intracavernosal injection with 10-20 μg of PGE1 and continued for 30 min. The measurements were obtained alternately from both deep penile arteries. The variables analyzed were the peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI), calculated as (PSV-EDV)/PSV. Erection Hardness was evaluated subjectively using the EH Score (EHS), a 5-point response score denoting how the patient would rate his erection. ED was subjectively assessed using the International Index of Erectile Function (IIEF-5) questionnaire. In patients with a diagnosis of vasculogenic ED, intracavernosal PGE1 injection was started with a 5 μg dose and then increased in 5 μg increments until the final dose of 20 μg was reached.Results:PSV of cavernosal arteries (CA) varied between 19.2 and 106.2 cm/s (mean: 43.8 ± 18.2) among the entire patients and between 19.7 and 80.2 cm/s (mean: 42.6 ± 11.3) among patients with arteriogenic ED. Arteriogenic ED was found in 8 patients (15.3%), while venogenic ED was observed in 12 patients, which constituted 23% of the entire study population and mixed arteriogenic-venogenic ED was found in 6 patients (11.5%) of the study population. DICC performed on patients diagnosed with venogenic ED on color Doppler ultrasonography revealed venous leakage and no statistically significant differences between results of DICC and color Doppler ultrasonography were found in EDV, RI, and PI measurements (P< 0.005). Among patients with venogenic ED and mixed arteriogenic-venogenic ED,2 patients had a normal erectile response and the remaining 16 received 2 mg phentolamine. A significant increase in PSV between baseline and 20 mg PGE1 (P < 0.001) was observed in all cases. Following phentolamine, there was a significant increase in grade of erection (P = 0.0001) and a significant reduction in the EDV (P = 0.0001). A reduction of the EDV to below 0.0 cm/s was observed in 12 patients. In patients with arteriogenic erectile dysfunction, mean (±standard deviation) duration of erection for consecutive doses of PGE15 μg, 10 μg, 15 μg, and 20 μg were 42.2±18.4, 55.4±24.1, 66.1 ± 31.1, and 83.3±36.7 minutes, respectively, with significant increase for each dose. In patients with veno-occlusive dysfunction, mean durations of erection significantly increased from 9.1±8.0 minutes at 10 μg to 19.2±9.8 minutes at 20 μg.Conclusion:In the current study, 50% of patients had vasculogenic ED and “false-positive’’ diagnosis of venous leakage was unmasked by phentolamine re-dosing. It is therefore imperative that patients with ED benefit from duplex color Doppler ultrasonography which is safe, cheap and non-ionizing diagnostic modality before initiating therapy as ED treatment is cause specific.

Testosterone level and endothelial dysfunction in patients with vasculogenic erectile dysfunction.

The association between endothelial dysfunction and late onset hypogonadism (LOH) in patients with vasculogenic erectile dysfunction (ED) is not yet well settled. Our objective was to assess the association between LOH and endothelial dysfunction in patients with vasculogenic ED. Throughout 2014-2015 a total of 90 men were enrolled in this cross-sectional observational study. Of them 60 patients with a clinical diagnosis of ED were further subdivided into two equal groups: patients with vasculogenic ED and LOH (A); patients with vasculogenic ED and euogonadal (B). Thirty age-matched men with no ED or hypogonadism were enrolled as control group (C). All patients were subjected to detailed medical and sexual history, total testosterone (TT), calculated free (FT) and bioavailable testosterone (BT), flow cytometric evaluation for endothelial progenitor cells (EPCs) (CD45negative/CD34positive/CD144positive) and endothelial microparticles (EMPs) (CD45negative/CD144positive/annexin V positive). The mean age ± SD of the three groups A, B and C were 51.3±11.1, 53.6±10.6 and 48.3±5years, respectively, with insignificant age differences (p=0.089). The diagnostic criteria of LOH were adapted according to European male aging study, 2010. The means of TT(ng/mL) were 2.32±0.21, 6.43±0.36 and 5.37±0.30 in groups A, B and C, respectively. There were highly significant differences between group A and groups B and C (p<0.001 for each). The means of EPCs were 0.43±0.070, 0.22±0.05 and 0.032±0.013 in groups A, B and C, respectively. The means of EMPs were 0.15±0.029, 0.056± .013 and 0.014±0.002 in groups A, B and C, respectively. There were significant differences between group C and groups A and B (p<0.05 for each). This study clearly demonstrated that there is a significant association between LOH and the higher expression of EPCs and EMPs in patients with vasculogenic ED.

Colour doppler sonography of the penis in the evaluation of erectile dysfunction: Our experience in Abuja, Nigeria.

Erectile dysfunction (ED) is an inability to achieve and maintain erectile rigidity sufficient for satisfactory sexual performance. It is either organic or psychogenic in origin. This study was aimed at establishing vasculogenic causes among patients being evaluated for ED using triplex Doppler Ultrasound. This study was conducted at the Department of Radiology, Federal Medical Centre, Abuja, Nigeria from July 2015 to January 2017. Thirty-five consecutive patients with the clinical diagnosis of ED were evaluated with colour Doppler ultrasound scan using a high-frequency linear transducer. The penile scan was done before and after intracavernosal injection of 10-20 μg prostaglandin E1. The waveforms of cavernosal arteries (CAs) were obtained alternately using angle of inclination ≤60°. The spectral waveforms and peak systolic velocities (PSV) of the CA were documented at 5-min intervals, from 5 to 50 min. PSV of CA varied between 19.5 and 104.4 cm/s (mean: 42.4 ± 17.6) among the entire patients and between 19.5 and 24.7 cm/s (mean: 21.9 ± 1.7) among patients with arteriogenic ED. Arteriogenic ED was found in six patients (17%), while venogenic ED was observed in ten patients, which constituted 29% of the entire participants. None had combined arteriogenic and venogenic ED. Peyronie's disease was observed in seven patients, and none of these had vasculogenic ED. About 46% of the patients had vasculogenic ED. It is therefore imperative that patients with ED benefit from this safe, cheap and non-ionising diagnostic modality before initiating therapy as ED treatment is cause specific.

Erectile Dysfunction, Testosterone Deficiency, and Risk of Coronary Heart Disease in a Cohort of Men Living with HIV in Belgium

Erectile dysfunction (ED) is more prevalent in men living with HIV (MLHIV) when compared with age-matched HIV-negative men. This may be related to a premature decline in testosterone levels. In the general population, ED has been associated with an increased risk for coronary heart disease (CHD). The aim of this study is to determine the prevalence of ED, testosterone deficiency, and risk of CHD in a cohort of young to middle-aged MLHIV in Belgium. A cross-sectional, observational study among 244 MLHIV attending the outpatient clinic of the Institute of Tropical Medicine in Antwerp. The short version of the international index of erectile function (IIEF-5) questionnaire diagnosed ED (cutoff score ≤ 21). The 10-year risk score for CHD was calculated. In a subset of men reporting ED, the calculated free testosterone (CFT) was determined using Vermeulen's formula. Testosterone deficiency was defined as CFT <0.22 nmol/L. One hundred fifty-one men (61.9%) self-reported ED (median IIEF-5 score: 16 [interquartile range (IQR) 12-19]). In multivariate analysis, only increasing age, but none of the HIV-related parameters, nor any of the individual cardiovascular-risk related parameters, was statistically significantly associated with ED. Eighteen out of the 49 (36.7%) men with ED who received a blood test to assess testosterone levels were diagnosed with testosterone deficiency. The 10-year risk of CHD in the cohort was 4.3% (IQR 3.6-5.7) and was significantly higher in men with ED (5.1%, IQR 4.4-6.6) compared with men without ED (3.1%, IQR 2.5-4.2). This study showed that ED and testosterone deficiency are highly prevalent in young to middle-aged MLHIV and that ED might be associated with an increased risk of CHD. Therefore, healthcare professionals should screen for clinical ED and should consider testing for underlying testosterone deficiency. A clinical diagnosis of ED should trigger a full evaluation of the patient's cardiovascular risk factors, even at younger age.

Emotional Changes in Men Treated With Sildenafil Citrate for Erectile Dysfunction: A Double‐Blind, Placebo‐Controlled Clinical Trial

Erectile dysfunction (ED) has been associated with several comorbidities and can cause significant loss of quality of life and self-esteem. In men with ED, to use the validated Self-Esteem and Relationship (SEAR) questionnaire to evaluate changes in self-esteem associated with sildenafil treatment of ED and to assess changes dependent on concomitant comorbid conditions. This was a 14-week, international, randomized, parallel-group, double-blind, flexible-dose (25, 50, or 100 mg), placebo-controlled study of sildenafil in men aged >or=18 years with a clinical diagnosis of ED (score <or= 21 on the Sexual Health Inventory for Men). The primary outcome was the change in the SEAR Self-Esteem subscale score from baseline to the end of treatment. Secondary outcomes were the change in SEAR component scores stratified by ED comorbidity, the change in the International Index of Erectile Function (IIEF) domain scores and in the intercourse success rate, and the response to the global efficacy assessment and to the global satisfaction assessment. A total of 841 patients were included in the intent-to-treat efficacy analysis (559 sildenafil, 282 placebo). Patients randomized to sildenafil had significantly greater change scores from baseline to the end of treatment on all components of the SEAR and all domains of the IIEF (P < 0.0001) compared with placebo. This finding was also consistent for all SEAR components when stratified by each ED comorbidity. In the sildenafil group, the improvement in the mean Self-Esteem subscale score correlated with improvements in the mean Erectile Function domain score (r = 0.6338, P < 0.0001). The physiologic and emotional benefits of sildenafil in the treatment of ED were confirmed, overall and in men with comorbid hypertension, hyperlipidemia, benign prostatic hypertrophy, and/or depression. Using both the IIEF and the SEAR questionnaires provides a more complete assessment of ED.

Vascular Impairment of Erection in Patients with Diabetes and Peyronie's Disease: Is that Accumulative?

The vascular impairment of erection has been shown in diabetic patients as well as in patients with Peyronie's disease (PD). However, the impact of both conditions together on vascular impairment has not been well addressed. The aim of this study was to assess the impact of type 2 diabetes mellitus (DM) and PD solely, and together, on impairment of vascular status of erection in patients with erectile dysfunction (ED). Three hundred four male patients with a clinical diagnosis of ED who visited our Andrology clinic and who had DM and/or PD were enrolled in this study. Of the patients, 214, 28, and 62 had DM, PD, and both DM and PD, respectively. Patients were interviewed for ED using the International Index of Erectile Function. All patients were also interviewed for sociodemographic data and medical comorbidities including DM. The diagnosis of PD was based on a palpable penile plaque or acquired penile curvature. Color Doppler ultrasonography was used to evaluate the hemodynamics of erection in all patients. We assessed the impact of type 2 DM and PD on erectile function (EF) domain and on deterioration of Doppler parameters of erection. Age, obesity, smoking, and medical comorbidities were significantly higher in patients with both DM and PD than in patients with any of the conditions alone. The means of EF domain, Q3, and Q4 were significantly lower in patients with both DM and PD than in patients with any of the conditions alone. Patients with DM only had significantly lower means of EF domain, Q3, and Q4 than patients with PD only. The means of peak systolic velocity and resistive index were significantly lower, and the means of end-diastolic velocity were significantly higher in patients with both DM and PD than in patients with any of the conditions alone. Type 2 DM and PD solely, and together, negatively affect the vascular status of erection. Type 2 DM demonstrated the principal effect; however, presence of PD has an additive impairment effect on erection and Doppler parameters.

Self-Esteem, Confidence, and Relationships in Brazilian Men with Erectile Dysfunction Receiving Sildenafil Citrate: A Randomized, Parallel-Group, Double-Blind, Placebo-Controlled Study in Brazil

Psychosocial manifestations of erectile dysfunction (ED) differ across cultures. Understanding the treatment response to ED medications within cultural groups can aid in resource allocation and in developing treatment strategies. Evaluate the effect of sildenafil treatment on self-esteem, confidence, and sexual relationship satisfaction in Brazilian men with ED. The Self-Esteem and Relationship (SEAR) questionnaire, a validated, 14-question instrument developed to specifically address self-esteem and relationship issues within the context of ED. Men aged 18 years or older with a clinical diagnosis of ED (< or = 21 on the Sexual Health Inventory for Men) and in a stable relationship with a partner during the study were eligible. The primary end point was a change from baseline in the self-esteem subscale of the SEAR questionnaire. Thirteen Brazilian sites participated in a randomized, double-blind, placebo-controlled trial of sildenafil treatment for ED. Patients were randomized to receive either 50 mg of sildenafil (adjustable to 25 mg or 100 mg based on patient response) or matching placebo approximately 1 hour before anticipated sexual activity but not more than once a day. At the end of double-blind treatment, 63 and 66 patients in the placebo and sildenafil groups, respectively, from 13 Brazilian sites were assessed for efficacy. Brazilian patients receiving sildenafil had significantly greater improvements in their scores on the SEAR self-esteem subscale (42.9 [95% confidence interval 35.7-50.0]) compared with placebo (21.1 [95% confidence interval 13.7-28.6]; P < 0.0001). Effect sizes ranged from 0.91 to 1.25 for individual SEAR components. The psychosocial parameters in Brazilian men with ED assessed by the SEAR questionnaire showed significant improvements in self-esteem, confidence, and relationships after treatment with sildenafil.