Evaluation Of Erectile Dysfunction Research Articles

Relationship between Erectile Dysfunction and Silent Coronary Artery Disease: Detection with Multidetector Computed Tomography Coronary Angiography

Aim: Our aim was to determine the relationship between erectile dysfunction (ED) and silent coronary artery disease (CAD) by multidetector computed tomography (MDCT) coronary angiography. Methods: Thirty consecutive men with nonhormonal and nonpsychogenic ED and with no cardiac symptoms were evaluated. Medical history, physical examination and laboratory investigation were performed. The five-item brief form of the International Index of Erectile Function (IIEF-5) was performed for evaluation of ED. The Agatston score (AS) was determined from MDCT images under beta blockade to induce bradycardia. The MDCT coronary angiography findings were evaluated by two radiologists blinded to the clinical findings. Patients were classified into three categories (mild, moderate and severe ED) according to IIEF-5 scores and into five categories (very low, low, moderate, moderately high and high CAD risk) according to the AS. Results: Mean age was 58.3 ± 8.7 years (46-79). 6 patients had hypertriglyceridemia, 4 had hypercholesterolemia and 4 had hyperglycemia. All patients had normal early morning testosterone levels. Regarding IIEF-5 scores, none of them had mild ED, 14 had moderate ED and 16 had severe ED. Of the 14 patients with moderate ED, 21.4% had low and 28.5% had moderate CAD risk regarding AS. Of the 16 patients with severe ED, 25% had moderate, 31.2% had moderately high and 25% had high CAD risk regarding AS. Increasing age was a risk factor for high AS (p = 0.045). There was a significant correlation between AS and ED severity (p = 0.01). Conclusions: ED and CAD often coexist. MDCT coronary angiography can detect coronary lesions and allow appropriate medical intervention.

1173 ETIOLOGIC EVALUATION OF ERECTILE DYSFUNCTION IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20131173 ETIOLOGIC EVALUATION OF ERECTILE DYSFUNCTION IN MEN WITH CHRONIC PROSTATITIS/CHRONIC PELVIC PAIN SYNDROME Gregory Lieser and Daniel Shoskes Gregory LieserGregory Lieser Cleveland, OH More articles by this author and Daniel ShoskesDaniel Shoskes Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.810AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A high proportion of men with Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), also known as NIH category III prostatitis, complain of erectile dysfunction (ED). The etiology of ED in these patients is not known. We present a cohort of patients with ED and CP/CPPS evaluated with hormonal, endothelial and vascular hemodynamic tests and correlated these findings with their symptom severity and disease phenotype. METHODS A cohort of patients with both ED and CP/CPPS who completed full ED evaluation was identified from our MenÆs Health Registry. None had ED prior to developing CP/CPPS. The CP/CPPS phenotype was determined clinically using the UPOINT system. International Index of Erectile Function (IIEF) and NIH Chronic Prostatitis Symptom Index (CPSI) scores assessed symptom severity. Patients had color penile Doppler with pharmacologic erection, Endopat measurement of peripheral arterial tone (PAT) plus free and total serum testosterone. RESULTS A total of 10 patients met all criteria, with a mean age of 32.9 (range 19-43). There was no correlation between severity of ED or CPPS symptoms by IIEF (mean 32 +/− 8.7) and CPSI (mean 20.9 +/− 4.2) scores. One patient had a marginally low total testosterone (260 ng/dl, mean of group 478). Three patients had abnormal PAT (suggesting early systemic arterial disease). Four patients had abnormal penile hemodynamics: 3 with decreased arterial flow (peak systolic velocity < 30 cm/s), 1 with veno-occlusive disease (end diastolic velocity > 5 cm/s) and 1 patient with both arterial and venous disease. In this young cohort, age did not correlate with vascular findings. Interestingly, both patients with veno-occlusive disease were positive for the pelvic floor Tenderness domain in their UPOINT phenotype and all 3 patients with decreased arterial penile blood flow were positive for both Tenderness and Psychosocial (depression or catastrophizing) domains (p=0.03 by Fisher Exact test). CONCLUSIONS Most young men who develop ED as a complication of CP/CPPS have normal hormonal and hemodynamic testing, suggesting a psychogenic cause related to pain and/or stress. There is however a smaller but potentially significant group with abnormal hemodynamics that may point to increased cardiac risk. This association between abnormal hemodynamics and pelvic floor spasm may suggest an etiologic link and could support the benefit of pelvic floor physical therapy for ED in those CP/CPPS patients positive for the “Tö” domain in their UPOINT phenotype. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e479 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Lieser Cleveland, OH More articles by this author Daniel Shoskes Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Lack of predictive correlation between peripheral arterial tone and colour flow Doppler parameters in men with erectile dysfunction

To evaluate whether peripheral arterial tone (PAT) can predict the results of penile colour flow Doppler in the evaluation of erectile dysfunction (ED). Fifty men presenting to an ED clinic were tested with an Endo-PAT2000 machine (Itamar Medical, Caesarea, Israel), which assessed augmentation index (AI), a measure of arterial stiffness, and reactive hyperaemia index (RHI), a measure of endothelial vasodilatation. Penile haemodynamics were measured and used to identify both arterial insufficiency (abnormal peak systolic velocity [PSV]) and veno-occlusive disease (abnormal end diastolic velocity [EDV]) after pharmacological erection with prostaglandin E1 using colour flow Doppler. Between-group comparisons were carried out using a Wilcoxon rank-sum test for continuous variables and a chi-squared test for categorical variables. Simple and multivariable logistic regression analyses were used to analyse the correlation between outcome measures. Using Doppler analysis, 58% of patients were found to have arterial insufficiency (abnormal PSV) and 48% had veno-occlussive disease (abnormal EDV). Using the Endo-PAT machine, 44% of patients were found to have increased arterial stiffness (abnormal AI) and 54% had decreased endothelial relaxation (abnormal RHI). Neither AI nor RHI were correlated with PSV or EDV. The closest association was between high AI and low PSV, with a sensitivity of 0.55 and specificity of 0.71. In our patient cohort, PAT did not reliably predict the results of penile Doppler. The two tests appear to measure different although potentially complementary aspects of the local and systemic vasculature.

Translation, Cross‐Cultural Adaptation, and Psychometric Validation of the 5‐Item International Index of Erectile Function (IIEF‐5) into Urdu

Patients suffering from erectile dysfunction (ED) feel shy to discuss this issue with their physician. Self-report questionnaires are a key instrument to break this barrier. Most of these questionnaires are in English, and their validated translations in Urdu, the official language of Pakistan, are not available. The aim of our study is to translate, cross-culturally adapt, and perform psychometric validation of an Urdu translation of the 5-item international index of erectile function (IIEF-5). The translation of IIEF-5 was done in Urdu and was refined through reverse translation and expert committee reviews. It was then pretested on 20 bilingual men and reviewed again to develop a final Urdu version of the questionnaire. We selected 47 patients who had been in a stable sexual relationship over the past 6 months and asked them to fill out the IIEF-5 questionnaire in both languages (Urdu and English), followed by evaluation of ED by a clinician, who was blinded to the responses of the patient to the questionnaire. The self-report to questionnaire and independent clinical assessment were compared. Patients refilled out the questionnaire again at the end of the interview to assess test-retest consistency. These data were now analyzed statistically using descriptive statistics, Cohen's kappa, and Cronbach's alpha analysis. The Cohen's kappa showed a very high degree of agreement between the two versions (P < 0.0001), and a high degree of internal consistency was demonstrated on Cronbach's alpha analysis ([0.882] with 95% confidence interval [0.839-0.916]). The clinical assessment of the presence and severity of ED also matched with the self-report questionnaire. We can safely conclude that this Urdu version of IIEF-5 is a valid instrument for use in the literate population of Pakistan.

Endovascular Therapy for Vasculogenic Erectile Dysfunction

Erectile dysfunction (ED) is an important clinical condition that affects a significant proportion of men. Although there are many etiologies for ED, many cases have a vascular basis that is related to inadequate arterial inflow, veno-occlusive dysfunction, or abnormalities in smooth muscle (cavernosal tissue) relaxation. These vascular abnormalities can exist in isolation or combination. Since the advent of phosphodiesterase-5 inhibitor (PDE5i) therapy, the initial management of ED in most cases consists of a brief medical evaluation followed by a trial of PDE5i therapy. However, up to 50% of men have an inadequate response to PDE5i therapy and discontinue therapy. Subsequent therapies for ED are increasingly invasive, including penile injection of vasodilators, vacuum pumps, and penile implants. With increased awareness of ED among clinicians and the growing mechanistic link between ED and atherosclerotic vascular disease, there has been renewed interest in the diagnosis and management of arteriogenic ED. Prior reports in the 1980s described the existence of arterial inflow lesions in patients with ED, and there are a modest number of reports describing the feasibility of revascularization with balloon angioplasty. Despite initial clinical success, enthusiasm for this technique waned, presumably because ED frequently recurred due to restenosis and lack of small vessel endovascular therapies. Recent investigation and the availability of newer tools such as drug-eluting stents have renewed interest in this field. Although conceptually attractive, endovascular therapy for ED presents significant challenges related to unanswered questions such as the prevalence and appropriate diagnostic evaluation of arteriogenic ED, and the safety and feasibility of stent-based therapies in this population. In addition, the evaluation, management, and follow-up of patients with vascular ED require a multi-disciplinary team with specialists in urology, sexual medicine, and vascular medicine. Despite these challenges, the potential for endovascular treatment of these patients remains one of the most exciting areas of investigation in vascular medicine.

Evaluation of Erectile Dysfunction and Associated Factors in Type-II Diabetic Patients in Birjand, Iran in 2008-2009.

Erectile dysfunction (ED) is one of the important complications in diabetic patients. Various factors trigger the onset and intensity of erectile dys-function. This study was done to determine the prevalence of erectile dysfunction and some associated factors among type II-diabetic patients in Birjand, Iran. In this cross-sectional study, which was carried out in Birjand during 2008 and 2009, 171 male diabetic patients aged 29 to 76 years who were sex-ually active and had no history of prostate surgery were included. Data on demographic characteristic and history of diabetes was collected using a questionnaire. International Index of Erectile Dysfunction-5 and Beck's standard questionnaire were used to determine erectile dysfunction and depression, respectively. Data were analyzed using multiple statistical tests including chi square, t-test, and logistic regression. The mean age of study population was 52.78 [95% CI: 51.25, 54.32] years (range between 29 to 76 years) and 43.3% of individuals were under 50 years. ED was diagnosed in 140 out of 171 (81.9%) diabetic patients. ED was mild in 28 (20%) subjects, moderate in 66 (47.1%), and sever in 46 (32.9%). Suffering from Long-term of diabetes (P<0.001), progressive depression (P<0.001), increased level of HbA(1)c (P<0.001), and decreased level of HDL (P<0.001) were among the most related factors with ED. The prevalence of ED is high among diabetic patients. Control of the disease and its relevant risk factors might be helpful in decreasing sexual dysfunction in diabetic patients.

Penile Doppler study: an evolving study in the evaluation of erectile dysfunction

Journal of Men's HealthVol. 8, No. 3 ISMH Congress 2011 AbstractsPenile Doppler study: an evolving study in the evaluation of erectile dysfunctionAbstract ID: #0038A. Saxena, V. Rajkumari, S. Garanayak, and M.M. MohibeeA. SaxenaSearch for more papers by this author, V. RajkumariSearch for more papers by this author, S. GaranayakSearch for more papers by this author, and M.M. MohibeeSearch for more papers by this authorPublished Online:14 Nov 2013https://doi.org/10.1016/j.jomh.2011.08.040AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Penile Doppler study: an evolving study in the evaluation of erectile dysfunction." Journal of Men's Health, 8(3), p. 220FiguresReferencesRelatedDetails Volume 8Issue 3Oct 2011 InformationWPMH GmbHTo cite this article:A. Saxena, V. Rajkumari, S. Garanayak, and M.M. Mohibee.Penile Doppler study: an evolving study in the evaluation of erectile dysfunction.Journal of Men's Health.Oct 2011.220-220.http://doi.org/10.1016/j.jomh.2011.08.040Published in Volume: 8 Issue 3: November 14, 2013PDF download

Evaluation of Lipid Profile as Indicators for Patients with Erectile Dysfunction

Patients with cardiovascular diseases or erectile dysfunction initially present to primary care physicians, who have an opportunity to intervene early andfavorably affect the clinical course of either condition. Recognition and aggressive treatment of cardiovascular disease risk factors has a major role in management of cardiovascular disease and erectile dysfunction.Twenty Iraqi patients with age range of 45-50 years were considered in this study. The evaluation of erectile dysfunction was according to NIH ConsensusDevelopment Panel on Impotence Procedure. The NIH provided complete information about severity of erectile dysfunction by using its questionnaire. Thelipid profile was performed individually. The obtained results predicted elevation of all lipid profile parameters. The results were as follow: Cholesterol 6.65±0.27 mmol/L, triacylglyceral 5.93±0.22 mmol/L, LDL-cholesterol 4.424 ± 0.28 mmol/L,VLDL 1.19 ±0.18 mmol/L and HDL 1.04 mmol/L.All collected results showed strong evidence between increased on serum lipids and erectile dysfunction and laboratory evaluation of lipid showed performedto patients with erectile dysfunction.

Increased incidence of Leydig cell tumours of the testis in the era of improved imaging techniques

To report an observed high frequency of Leydig cell tumours (LCTs) diagnosed at our centre. Charts of all patients who underwent surgery for a testicular tumour between 1999 and 2008 at our department were searched and data from patients with LCT were collected. Before surgery all patients underwent ultrasound and complete staging. In all but two patients with LCT an organ-sparing surgery was performed. Surgery was performed under ultrasound or palpation guidance. All patients underwent postoperative follow-up. We retrospectively reviewed surgical technique, histology, epidemiology and outcome in all LCT patients. In the study period, 197 testicular tumours were surgically removed of which 29 were diagnosed as LCT (14.7% of 197; further study group) in 25 patients. Mean age of patients with LCT was 45 years (range 21-68 years). Tumour size ranged from 1.2 to 80 mm (mean 10.23 mm). In two patients (8%) the lesion was palpable whereas incidental diagnosis was made in seven patients (28%). In the remaining patients diagnosis was made by ultrasound performed for testicular pain (six patients, 24%) or during infertility or erectile dysfunction evaluation (10 patients, 40%). Definitive histology reported no malignant histopathological features in all but one patient; this particular patient experienced tumour progression after 2 months and died from advanced disease 1 year later. All other patients are free of disease after a mean follow up of 56 months (range 7-93 months). During this period one patient developed a second LCT on the contralateral side; another patient had a recurrence within the same testicle, but on the opposite pole. Both underwent a subsequent organ-sparing tumour resection. The percentage of LCT (14.7% of all testicular tumours removed) was significantly higher than expected from the literature. One possible explanation for this phenomenon is the increasing use of better ultrasound technology and the subsequent increased detection of small nodules that have not been found in historical series. Use of 'observation-only' for very small lesions detected at infertility clinics is under debate.

Evaluation of erectile dysfunction and associated cardiovascular risk using structured questionnaires in Chinese type 2 diabetic men

Erectile dysfunction (ED) is not uncommon, but frequently underdiagnosed in type 2 diabetic men. In this study, we aimed to explore the frequency and severity of ED in Chinese type 2 diabetic men using a structured questionnaire. We furthermore sought to investigate the associations of ED with diabetes-related complications and metabolic indices. A consecutive cohort of 313 Chinese type 2 diabetic men aged between 25 and 76 years attending a diabetic centre were recruited between October 2006 and June 2007. Of the study population, the frequency of ED was 39.3% according to the National Institutes of Health (NIH) Consensus Conference criteria, compared with 84.3% (41.7% of them having moderate to severe ED) as diagnosed by International Index of Erectile Function (IIEF-5) questionnaire. After adjusting for potential confounding factors by multivariable logistic regression, ED defined by NIH criterion was associated with advanced age [OR = 1.05 (95% CI 1.01-1.09), p = 0.012], the presence of diabetic retinopathy [OR = 2.43 (95% CI 1.27-4.66), p = 0.008] and coronary heart disease [OR = 2.63 (95% CI 1.21-5.70), p = 0.015]. ED defined by IIEF-5 was associated with advanced age [OR = 1.12 (95% CI 1.06-1.17), p < 0.0001], use of insulin therapy [OR = 2.94 (95% CI 1.12-7.73), p = 0.029] and urinary albumin-creatinine ratio [OR = 2.29 (95% CI 1.05-5.01), p = 0.037]. In conclusion, ED was highly prevalent in Chinese type 2 diabetic men and was associated with multiple cardiovascular risk factors and complications. Advanced age, use of insulin therapy, the existence of microvascular complications such as retinopathy, albuminuria and coronary heart disease were associated with ED. NIH criteria diagnosed a much lower rate of ED compared with IIEF-5. Overall, structured questionnaires are useful and objective tools to detect ED, which should prompt a comprehensive risk assessment in these subjects.

Diagnostic Tests for Male Erectile Dysfunction Revisited: Committee Consensus Report of the International Consultation in Sexual Medicine

The Committee on "Clinical Evaluation and Scales in Sexual Medicine" of the third International Consultation in Sexual Medicine reviewed current practice and new developments in the field of physiological testing in male erectile dysfunction (ED). To provide an overview of current practice and new developments in the field of diagnostic testing in male ED. The Pubmed literature was reviewed. Since the 1980s of the last century, a broad array of specialized physiological tests has been used for assessing ED. The notion that ED often is an (early) symptom of generalized cardiovascular disease and the introduction of oral pharmacological therapies that are effective irrespective of etiology has reduced the application of the "classical" tests to a minimum and has shifted the scope toward tests with demonstrated reliability in cardiovascular medicine. (i) The clinical utility of specialized tests in the evaluation of male ED is limited to a small minority of men; (ii) the scope of physiological testing has shifted toward tests with demonstrated reliability in cardiovascular medicine.

Evaluation of Erectile Dysfunction in Spinal Cord Injured Patients

Evaluation of Erectile Dysfunction in Spinal Cord Injured Patients

Abklärung der erektilen Dysfunktion beim Primärversorger

The evaluation of erectile dysfunction should assess correctable etiologic diseases. A structured evaluation is recommended because of its semi-quantitative and reproducible nature. This evaluation primarily follows a therapy-oriented strategy. Therefore patient and physician should define treatment goals early in the course. Those treatment goals may change within the life cycle. Interview and clinical assessment are the corner stones of evaluation. Invasive testing is less important nowadays.

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Although penile duplex Doppler ultrasound studies have been well described for evaluating erectile dysfunction (ED), standardization of test methodology remains difficult. Moreover, the clinical correlation of ultrasound-derived vascular flow values for diagnosis and therapy of ED is not always straightforward. We report a relatively small series of Doppler studies to highlight a particular parameter, time to the maximum peak systolic velocity, not thoroughly addressed in previous studies. Editorial CommentUrologyVol. 75Issue 1PreviewThe authors propose the division of a small number of patients with ED with or without Peyronie disease into fast or slow responders based on time to maximum peak systolic velocity (PSV) obtained on a color duplex Doppler study. The slow responders had a higher eventual PSV and had a higher number of PSVs of 30 cm/s or higher. However, usefulness of this division for ramifications for classifying ED characteristics of the 2 groups was not present. Certainly, the value of this well-written study is the lesson for necessity to follow-up patients beyond 10 minutes for obtaining maximum systolic velocity. Full-Text PDF Longer Time to Peak Flow Predicts Better Arterial Flow Parameters on Penile Doppler UltrasoundUrologyVol. 75Issue 1PreviewTo review the associations between measured variables in Penile Doppler ultrasound procedures. Penile Doppler ultrasound is useful in the evaluation of erectile dysfunction, but there is no uniform standard of performing the procedure. It is generally believed that a peak systolic velocity > 30 cm/s, minimal venous leak, and resistive index > 0.8 are essential for adequate erection. While the arterial parameters are well studied, data on the predictive value of time to peak flow are lacking. Full-Text PDF

Longer Time to Peak Flow Predicts Better Arterial Flow Parameters on Penile Doppler Ultrasound

To review the associations between measured variables in Penile Doppler ultrasound procedures. Penile Doppler ultrasound is useful in the evaluation of erectile dysfunction, but there is no uniform standard of performing the procedure. It is generally believed that a peak systolic velocity > 30 cm/s, minimal venous leak, and resistive index > 0.8 are essential for adequate erection. While the arterial parameters are well studied, data on the predictive value of time to peak flow are lacking. Penile duplex Doppler ultrasounds performed for either erectile dysfunction or Peyronie's disease evaluation were reviewed. Clinical records, International Index of Erectile Function scores, and ultrasound variables were examined. "Fast" responders reached maximal peak systolic velocity (PSV) < or = 10 minutes, whereas "slow" responders reached maximal PSV between 15 and 25 minutes. Of 146 total patients, 36 (25%) were fast responders and 110 (75%), slow responders. No preprocedural characteristics, including the Erectile Function domain score of the International Index of Erectile Function, predicted time to peak flow. Compared with the fast responders, slow responders had higher mean PSV (left: 33.9 +/- 19.5 vs 25.0 +/- 11.7 cm/s, P = .01; and right: 36.4 +/- 21.3 vs 25.0 +/- 13.3 cm/s, P = .002). There was also a higher percentage of patients with average PSV > 30 cm/s in slow responders (58% vs 36%, P = .02). There were no significant differences in baseline characteristics between slow and fast responders. However, slow responders did seem to have significantly better arterial flow parameters, although penile dimensions, cavernosal artery diameter, Erectile Function domain scores, and subjective rigidity were similar.

The Correlation Between Intracavernosal Pressure and Cavernosal Blood Oxygenation

Given that regular nocturnal erections are physiological, it has been suggested that erections are pivotal to the maintenance of erectile tissue health. It has been postulated that a critical element to erectile tissue protection is cavernosal oxygenation. It is accepted that the corpora cavernosa are oxygenated fully during a rigid erection. However, it remains unknown what degree of penile rigidity is required to achieve cavernosal oxygenation at the arterial level. This analysis was undertaken to define the correlation between intracavernosal pressure (ICP) and cavernosal oxygen partial pressure (pO(2)). Cavernosal pO(2) at various ICPs. Methods. The study population was comprised of patients undergoing dynamic infusion cavernosometry (DIC) in the evaluation of erectile dysfunction or prior to penile reconstructive surgery. DIC was conducted with a standard vasoactive agent redosing schedule. One milliliter of corporal blood was aspirated at various ICPs into a heparinized syringe for later pO(2) analysis. Blood was placed on ice immediately and transported to the laboratory upon completion of the DIC. Twenty-one blood samples were analyzed from 13 patients. Mean patient age was 43 +/- 18 years. Blood specimens were collected at an ICP range of 6-90 mm Hg. Mean +/- SD pO(2) was 39 +/- 11 mm Hg at ICP < 10 mm Hg, 87 +/- 3 at ICP 11-20 mm Hg, 89 +/- 6 at ICP 21-45 mm Hg and 96 +/- 13 at ICP > 45 mm Hg. Significant increases in cavernosal oxygenation occur in the earliest stages of erection at relatively low ICP. These findings suggest that partial erections may be sufficient to oxygenate erectile tissue and protect it from prolonged hypoxia-induced damage.

Ketoconazole and Prednisone to Prevent Recurrent Ischemic Priapism

To our knowledge no standard therapy exists for the prevention of recurrent ischemic priapism. We used ketoconazole and prednisone with dosing titrated according to serum testosterone levels to suppress sleep related erections in an attempt to prevent recurrent episodes. Eight patients with recurrent ischemic priapism were treated with ketoconazole and prednisone. Two patients had sickle cell anemia and 6 had idiopathic recurrent ischemic priapism. Testosterone was measured on initial presentation, and ketoconazole and prednisone dosing was titrated to approximately 200 ng/dl testosterone and based on the presence or absence of recurrent ischemic priapism episodes. The International Index of Erectile Function-5 questionnaire was administered to evaluate for erectile dysfunction. Patients were seen monthly and therapy was withdrawn after 6 months. Mean testosterone before and after treatment was 468 and 275 ng/dl, respectively. Mean followup was approximately 1.5 years. One patient had 2 recurrent ischemic priapism episodes while on ketoconazole and prednisone treatment. Another patient experienced an increase in testosterone from 361 to 432 ng/dl after initiation of therapy, and 3 recurrent ischemic priapism episodes requiring emergency corporal irrigation. After dose titration testosterone was 184 ng/dl and the patient has had no subsequent episodes. Mean International Index of Erectile Function-5 score was 24.8 points. There were no recurrent ischemic priapism episodes after withdrawal of ketoconazole and prednisone, and no reported symptoms of hypogonadism. Ketoconazole and prednisone therapy was well tolerated in these 8 patients with recurrent ischemic priapism, and with testosterone monitoring and dose titration it was successful in preventing recurrent episodes while preserving sexual function.

The Use of IIEF-5 for Reporting Erectile Dysfunction Following Nerve-Sparing Radical Retropubic Prostatectomy

Introduction: Increased detection of organ-confined prostate cancer has led to an increased demand for nerve- sparing surgery. Most studies of erectile dysfunction (ED) following nerve-sparing radical prostatectomy (RRP) use sin- gle-item assessment, and potency rates differ widely among various groups. We aimed to investigate use of IIEF-5, a validated questionnaire, for reporting ED following RRP. Aims: To study use of IIEF-5 questionnaire in evaluation of post-RRP ED, and to find possible variations in ED reporting when comparing IIEF-5 to single-item assessment. Methods: At a minimum of 18 months post-surgery, patients completed a questionnaire on erectile function that included both single-item assessment and IIEF-5. The study included sexually active patients who reported no pre-operative ED and who did not receive adjuvant or salvage therapy. Main Outcome Measures: For single-item assessment, potency was defined as the ability to achieve erections firm enough for intercourse. For IIEF-5 questionnaire, potency was defined as a score >22 (out of 25) points. Results: Ninety-one patients were included in study. The procedures consisted of bilateral nerve-sparing (55%) or uni- lateral or partial bilateral nerve-sparing surgery (45%). We found a striking difference in potency rates when using either IIEF-5 score or single-item assessment for reporting of potency after RRP. The results when using IIEF-5 questionnaire indicated that 25.5% of all patients were potent. In contrast, single-item assessment indicated a potency rate of 53.8%. Conclusions: Using IIEF-5 questionnaire to evaluate ED following RRP results in a remarkably lower percentage of men being classified as having no ED. This might be main reason IIEF-5 is not frequently used in reporting of ED following radical prostatectomy. Literature search reveals that IIEF-5 questionnaire is expected to have a higher level of validity, accuracy, and reliability, and may be more stable than single-item assessment. We think that use of IIEF-5 in reporting of ED following RRP enhances comparison of different series and of different treatment modalities. How- ever, a prospective comparison between IIEF-5 and single-item assessment is needed to confirm this finding.

Amino-Terminal Pro-C-Type Natriuretic Peptide is Associated with the Presence, Severity, and Duration of Vasculogenic Erectile Dysfunction

BackgroundEndothelial dysfunction is a key event in the pathophysiology of erectile dysfunction (ED) and generalized vascular disease. C-type natriuretic peptide (CNP) is a paracrine molecule that effects endothelial integrity and vascular tone. ObjectiveTo determine the role of CNP in men with vasculogenic ED. Design, setting, and participantsFifty-two consecutive men (age: 57±10 yr) with nonpsychogenic and nonhormonal ED for >6 mo and free of cardiovascular disease who were referred to the Cardiovascular Diseases and Sexual Health Unit of our Department for evaluation of ED were compared with 31 subjects with normal erectile function matched for age, body mass index, and traditional risk factors. MeasurementsVasculogenic ED was diagnosed according to comprehensive history, physical examination, Sexual Health Inventory for Men (SHIM-5) scoring, hormonal testing, and penile color-Doppler ultrasound. Amino-terminal proCNP (NT-proCNP) was measured in plasma with enzyme-linked immunosorbent assay (ELISA). Results and limitationsCompared to controls, ED patients had significantly lower NT-proCNP levels (0.21±0.08pmol/l in ED patients vs 0.34±0.07pmol/l in control subjects; p<0.001). NT-proCNP levels were associated with erectile performance as expressed by SHIM-5 score (r=0.57; p<0.001), even after adjusting for confounders. There was also an inverse linear relationship between ED duration and NT-proCNP levels (p<0.05). In patients with arteriogenic ED, there was a positive correlation of NT-proCNP levels with peak systolic velocity (PSV) (r=0.51; p=0.01). ConclusionsCNP levels are associated with the presence, severity, and duration of ED. These findings provide further insight into the role of CNP in the pathophysiology of ED.

Can the International Index of Erectile Function distinguish between organic and psychogenic erectile function?

To define the ability of the International Index of Erectile Function (IIEF) to differentiate between organic and psychogenic erectile dysfunction (ED). Patients presenting for the evaluation and treatment of ED who had penile duplex Doppler ultrasonography (DUS) completed the IIEF questionnaire. Accepted ranges of the IIEF EF domain were used to grade baseline severity (severe, moderate and mild < or =11, 11-17, 18-25, respectively). Accepted criteria were used to define normality on DUS (peak systolic velocity >30 cm/s and end-diastolic velocity <5 cm/s). Patients with documented Peyronie's disease, hypogonadism and a history of radical prostatectomy were excluded. In all, 112 patients were enrolled, with a mean (sd) age and duration of ED of 56 (16) and 2 (0.6) years, respectively. The vascular risk-factor profile included diabetes in 15%, hypertension in 26% and hyperlipidaemia in 20%. The baseline severity of ED was mild, moderate and severe in 28%, 41% and 32% men, respectively. All patients had normal testosterone levels. Patients also with a normal DUS were diagnosed with psychogenic ED, in 50%, 13% and 17% of men with mild, moderate and severe ED by the IIEF, respectively. No patient with venous leak had mild ED, and 62% of men with venous leak had severe ED. These results indicate that the IIEF is not completely accurate in differentiating between organic and psychogenic ED, and that almost a fifth of men in this study population with severe ED by the IIEF had normal erectile haemodynamics. These data have potential ramifications for evaluating the baseline severity of ED in trials of erectogenic agents.