Organic Causes Of Erectile Dysfunction Research Articles

(318) Factors Influencing Compliance with Trimix, an Intracavernosal Injection for Erectile Dysfunction: A Retrospective Analysis

Abstract Introduction Trimix, an intracavernosal injection therapy, is an effective treatment for erectile dysfunction. However, patient compliance with Trimix use is crucial for treatment success, and factors influencing compliance are not well understood. Objective This retrospective analysis aimed to identify factors that influence compliance with Trimix therapy among patients with erectile dysfunction. Additionally, the study aimed to investigate the impact of comorbidities, specifically diabetes and prostate cancer, on the duration of Trimix treatment. Methods Patient data from pharmacy records between 2017 and 2022 was analyzed. Custom Python code was used to calculate the duration of Trimix use based on the first and last prescription refill events. A comprehensive chart review was conducted to collect additional patient-related data, including demographics and comorbidities. Cox Proportional Hazards Regression models were employed to assess the effects of predictor variables on the duration of Trimix use. Simple linear regression was used to compare the presence of diabetes, prostate cancer, or both on time spent on Trimix treatment. Results The analysis included a total of 4,072 patients. Age was identified as a significant predictor of Trimix therapy discontinuation, with every additional year of age associated with an increased hazard ratio of 1.007 (p < 0.001). Preferred language also emerged as a significant predictor, with patients preferring Spanish exhibiting a higher hazard ratio of 1.163 compared to patients preferring English (p = 0.004). In terms of comorbidities, the presence of prostate cancer significantly differed from other organic causes of erectile dysfunction on time spent on Trimix treatment (p = 0.002), resulting in 80 fewer days of Trimix treatment. Conclusions This retrospective analysis revealed that age and preferred language are important factors influencing compliance with Trimix therapy. Older patients and those preferring Spanish were more likely to discontinue Trimix treatment. Additionally, the presence of prostate cancer significantly impacted the duration of Trimix treatment. These findings emphasize the need for age-specific counseling, language-concordant interventions, and tailored approaches to address comorbidities such as prostate cancer. Understanding these factors is vital for optimizing treatment adherence and efficacy in patients with erectile dysfunction. Disclosure No.

Use of Phytotherapy in the Treatment of Patients with Erectile Dysfunction

Erectile dysfunction (ED) is one of the most common sexual disorders. In men with a mild stage of ED, it is possible to achieve a therapeutic effect from the use of phytotherapy. The objective: analysis of the effectiveness of the combination of natural compounds in patients with mild ED. Materials and methods. 28 patients (average age – 35±5.3 years) with mild ED participated in the study of the effectiveness of the dietary supplement. All patients were examined before and 1 month after the use of the combination of natural compounds, namely: collection of a detailed medical and sexual history, ultrasound dopplerography of the vessels of the penis, lipidogram, blood glucose level and total testosterone level were measured in the laboratory. The patients received the dietary supplement, which includes zinc citrate, L-arginine, an extract of the fruits of slanky anchovies, an extract of epimedium leaves, an extract of the root of Tongkat Ali, an extract of the root of Korean red ginseng, 1 capsule 2 times a day. Results. During the study, a psychogenic form of ED was found in 12 (42.9%) men, an organic cause of ED in 3 (10.7%), and a mixed form in 13 (46.4%) men. 1 month after the end of the use of the complex, it was established that all indicators of the «International Index of Erectile Function-15» (MIEF-15) questionnaire improved in ED patients. Conclusions. The results of the study showed that the use of the complex significantly improved sexual satisfaction, sexual desire, orgasmic function and quality of life in men with mild ED.

Effect of increased prolactin and psychosocial stress on erectile function

IntroductionSexual dysfunctions in men are complex disorders that consist of organic and psychogenic components. The most common sexual dysfunction is erectile dysfunction. It is the inability to achieve or maintain an erection for satisfactory sexual performance. This disorder can be caused by high blood pressure, heart disease, vascular problems, psychological and hormonal factors such as problems with testosterone and prolactin levels.ObjectivesThe most common sexual dysfunction is erectile dysfunction. It usually affects men over the age of 40. The causes of erectile dysfunction can be organic, psychogenic or a combination of both. The most common organic causes of erectile dysfunction may be high blood pressure, diabetes mellitus, obesity or hormonal disorders. Psychogenic reasons are usually related to psychosocial stress. In this study, we tested the relationship between erectile dysfunction, hyperprolactinemia, and psychosocial stress.MethodsClinical examinations of 60 patients with erectile dysfunction, which also included psychosocial stress, focused on patient history, comprehensive sexological examination, biochemical analyzes of serum prolactin, total testosterone, thyroid stimulating hormone with psychometric evaluation of erectile function and a checklist of trauma symptoms (TSC-40)ResultsThe results show significant Spearman correlations of psychometric evaluation of erectile function with prolactin (R = 0.50) and results of the trauma checklist score (R = 0.55) as well as significant Spearman correlations between TSC-40 and prolactin (R = 0.52). This result indicates a significant relationship between erectile dysfunction, hyperprolactinemia and stress symptoms in men.ConclusionsOur result indicates a significant relationship between erectile dysfunction, hyperprolactinemia and stress symptoms in men.DisclosureNo significant relationships.

Вопросы этиологии эректильной дисфункции у мужчин с расстройствами мочеиспускания

Introduction. Erectile dysfunction is an urgent problem of modern urology. There is a consistent correlation between the sexual dysfunction incidence and the aging changes in the man’s body. In this study, an attempt was made to analyze the causes of the discussed correlation. An analysis comparing the data obtained with the worldwide figures and the results previously reported in Russia was performed. Materials and methods. The prospective multicenter epidemiological study was carried out using the data acquired from April 1 to May 31, 2017 during the anonymous questioning of 525 men (average age 64.2±9.93) living in Moscow, who had contacted the urologist due to urination disorders. The respondents answered the questions of the specially developed 140-point questionnaire. All demographic and medical data was taken into account, including information on comorbidities and age of onset. The IIEF, IPSS, QoL and AMS (Aging Male Screening) questionnaires were completed. Statistical processing of the results was carried out. Results. Complaints of sexual dysfunction are a relatively rare reason for the urologist’s consultation in men with LUTS living in the Moscow region. However, the survey has revealed that 39.9% of men did not consider themselves sexually active. The particularly low sexual health rate was detected in the age group over 70. The average IIEF questionnaire score for the respondents was 39.40±21.14. Less than a third of respondents reported their sexual life quality as acceptable. The correlation coefficient between the total IIEF score and the birth year was +0.422, and for the IPSS score it was -0.205. Correlations were considered significant when p<0.001. The erectile dysfunction risk increases with age, however, according to numerous publications it is not due to natural aging process, but due to severe comorbidities, particularly hypertension, infections, vascular diseases and diabetes mellitus. The patients' compliance with healthy lifestyle, abstention from smoking and regular drinking, is of great importance. In this study, the 152 of 525 (29%) respondents were smokers at the time of the survey. Strong liquor was routinely consumed by 250 respondents (47.6%), and low-alcohol beverages were consumed by 167 people (31.8%). The onset of the listed above comorbidities occurs at the age of 50–60, which makes it possible to explain the rapid ED incidence increase in the corresponding age group. The pattern identified constitutes evidence of the organic causes of erectile dysfunction. Conclusion. Analysis of the erectile dysfunction type and incidence in patients with LUTS living in the Moscow region demonstrated certain differences between the results obtained and the results of similar American and European studies. A steady trend of sexual health deterioration was observed in patients aged over 55–65. We have proved correlation between these changes and various cardiovascular diseases manifestations (CAD, hypertension), the peak period of which falls on the described age group. Comparison of the data obtained to those of 2012 has demonstrated increased severity of the “age-related” symptoms.

Evaluation of the Causes of Erectile Dysfunction in Patients Undergoing Penile Doppler Ultrasonography in Pakistan.

PurposeIn patients with erectile dysfunction, it is important to differentiate psychogenic from organic causes. Penile Doppler ultrasonography is a relatively inexpensive and minimally invasive tool for this purpose. This study was conducted to evaluate the causes of erectile dysfunction in an adult male population, using penile Doppler ultrasonography.Materials and MethodsA retrospective study was conducted in a single center. All patients who presented with complaints of erectile dysfunction and underwent penile Doppler ultrasonography between July 2014 and June 2016 were included in this study. All examinations were performed using GE Voluson S6 and GE Logiq P5 devices. Following baseline scans, an intracavernosal injection of 20 µg of prostaglandin E1 was given. Peak systolic and end diastolic velocities were measured in each cavernosal artery. Patients with a peak systolic velocity of <25 cm/s were considered to have arterial insufficiency, while an end diastolic velocity of >5 cm/s was considered to indicate venous incompetence.ResultsOut of 97 patients (mean age, 37.09±11.59 years; range, 19~69 years), 50 patients (51.5%) had normal findings, 24 patients (24.7%) had arterial insufficiency, 15 patients (15.5%) had a venous leak, and 8 patients (8.2%) patients had arterial insufficiency with a venous leak. Psychogenic erectile dysfunction was significantly higher among patients aged ≤40 years, while arterial insufficiency with or without a venous leak was significantly higher among patients aged >40 years (p=0.022).ConclusionsA majority of the studied individuals demonstrated no organic cause of erectile dysfunction, thus confirming a high prevalence of the psychogenic etiology, particularly in relatively young individuals.

Prevalence of Diabetes Mellitus (DM) in a population of men affected by Erectile Dysfunction (ED).

A) to evaluate the prevalence of patients affected by Diabetes Mellitus (DM) in a population of men with Erectile Dysfunction (ED); B) to define the epidemiological, biochemical and therapeutic aspects. N.934 subjects referred at our Andrology Unit for ED were studied. The diagnosis of ED was evaluated using the IIEF-5 questionnaire (Total score ≤21). The prevalence of subjects affected by DM in a population of men with ED was 19.5% (182/934). The age ranges were: ≥55 years (108/182; 59.3%); ≥40<55 years (70/182; 38.5%); <40 years (4/182; 2.2%). HbA1c mean value was 7.9% ± 0.8%. No significant differences were found in DM onset timing or in anti-diabetic treatment. In n.125/182 cases (68.7%) the ED onset followed the diagnosis of DM; in n.34/182 cases (18.7%) it appeared at the same time; and in n.23/182 cases (12.6%) appeared before DM diagnosis. in n.18/182 subjects (9.9%) there was a concomitant hypotestosteronemia; these patients were treated only with testosterone replacement; this treatment was efficacious (IIEF-5 total score ≥22) in 8/18 subjects (44.4%). In n.146/182 subjects (80.2%) a treatment with PDE5-i was given. Of these 146 subjects, the therapy was given "on demand" to 108 subjects (efficacy in 50.9%; 55/108) and "once a day" to the remaining 38 subjects (efficacy 63.1%, 24/38) (p=0.428, n.s.). N.15/182 subjects (8.2%) were treated with intracavernous injections of Alprostadil (efficacy in 8/15, 53.3%). In n.3/182 subjects (1.6%) a penile prosthesis was implanted. DM is one of the most frequent organic causes of ED; there were many strategies to treat this symptom without interfering with the antidiabetic treatment. Finally, ED can be predictive of DM.

Chronic Periodontitis and Erectile Dysfunction

We read the article by Oguz et al. [1] with great interest. The cited study is an interesting contribution to the literature. The relationship between erectile dysfunction (ED) and periodontal disease is explored. The cited authors conclude that an association exists between clinical periodontal parameters and ED. Further, they suggest that periodontal disease should be considered when it is sought to understand the etiology of ED in young adults. However, we suggest that these findings should be viewed with caution because some necessary data are lacking. First, the mean International Index of Erectile Function (IIEF) scores of participants were not reported. It is well known that IIEF scores can be used to grade ED severity as absent, mild, moderate, or severe [2]. Why did the authors not subdivide their group I patients in terms of the severity of ED? Had they done so, it would have been possible to draw a firm conclusion as to the existence of any correlation between ED and the presence of chronic periodontitis (CP). We would make another technical point. The possibility that some cases of ED were psychological in terms of etiology should have been explored in more detail [3]. The exclusion criteria were the presence of a systemic disease (including diabetes mellitus, heart disease, and hypertension); such conditions can affect periodontal health and ED. It was shown in the literature with a rat model that experimental model of periodontitis may cause ED [4]. Also, the authors argue that CP is an organic cause of ED, because CP may induce systemic vascular disease by triggering endothelial dysfunction, but in the study no psychological exclusion criterion was listed. It would have been possible to identify appropriate exclusion criteria had patients been asked about the presence of nocturnal erections, or had a nocturnal penile tumescence and rigidity test been performed.

Diabetes, coronary artery disease and erectile dysfunction doppler study

Objectives To assess the role of measuring cavernosal artery blood flow as a screening tool for ischemic heart disease in patients with erectile dysfunction (ED). Methods A total of 303 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. The penile vasculature was assessed using color Doppler ultrasonography and the Digital Inflection Rigidometer. All patients were referred to a cardiologist for evaluation of ischemic heart disease (IHD). All patients underwent routine laboratory investigations, plus total testosterone and prolactin assessments. Results Seventy-six percent of the patients had organic causes of ED. Of the 303 patients, 31.4% had different degrees of IHD. A statistically significant association was found between the presence of IHD and arteriogenic causes of ED, a poor response to intracorporal injection, poor rigidity in the Digital Inflection Rigidometer, and low peak systolic velocity (PSV) in the cavernosal arteries ( P P P Conclusions The results of this study established that a reduced PSV of the cavernous artery is associated with IHD. Determining the PSV could be a reliable screening tool for the detection of IHD in patients with ED.

Erectile Dysfunction

Erectile Dysfunction

Disfunción eréctil de origen vascular

Vascular etiology is present in up to 60% of the patients with erectile dysfunction (ED). Both small vessel disease, such as that in diabetes mellitus, and arteriosclerosis of bigger size arteries, as in hypertension, cause arterial insufficiency and erectile dysfunction. Tobacco smoking alters the arterial hemodynamics in the penis, causing erectile dysfunction in a high percentage of advanced age smokers: pelvic arteries fibrosis and stenosis accelerates the existing arteriosclerosis. Venous occlusive dysfunction may be due to the decrease of corpora cavernosa compliance or tunica albuginea inherent anomalies. Vascular endothelial growth factor may play a role in the modulation of vascularization of the normal penile architecture. Various events, all of them important, may cause erectile dysfunction. Moreover, no cause can participate independently. A cascade of situations (including psychological factors as well as organic) may lead to erectile dysfunction. A continuous understanding of organic causes of erectile dysfunction will allow physicians to discover treatments for their correction, as well as to give confidence to the patient.

ORIGINAL RESEARCH—ERECTILE DYSFUNCTION: Association of Risk Factors and Medical Comorbidities with Male Sexual Dysfunctions

Conventionally, little attention has been given to the association of risk factors and medical comorbidities with male sexual dysfunctions. Although that association has been recently shown in many studies, it is not yet well investigated in the Saudi community. To investigate the association of risk factors and medical comorbidities with male sexual dysfunctions in the Saudi community. A total of 1,464 male patients with a clinical diagnosis of sexual dysfunctions were enrolled in this study. All patients were assessed for sexual functions using different domains of the International Index for Erectile Function. Patients were also interviewed for sociodemographic data, medical history, and risk factors for erectile dysfunction (ED). Routine laboratory investigations, plus total testosterone and prolactin assessments, were offered to all patients. Assessments of penile vasculature using Doppler ultrasonography and rigidometer were performed. A total of 92.6% of the patients had ED, 50.8% had premature ejaculation (PE), and 7.6% had low sexual desire. There was a significant association between increased age and increased severity of ED. In total, 20% had psychogenic cause, whereas 80% had organic cause of ED. Of the patients, 10.2% had mild, 41% had moderate, and 48.8% had severe ED. There were significant associations between endocrinopathy and both low sexual desire and PE (P < 0.05). There were significant associations between increased severity of ED and presence of diabetes, hypertension, dyslipidemia, ischemic heart disease, myocardial infarction, and psychological disorders. There were significant associations between increased severity of ED and increased values of end diastolic velocity, decreased values of peak systolic velocity, resistive index, rigidometer, and decreased response to intracavernosal injection (P < 0.001). This study provides an assessment of the association of risk factors and medical comorbidities with male sexual dysfunctions in ambulatory service in this community.

A Rational Combination Pharmacotherapy in Men with Erectile Dysfunction who Initially Failed to Oral Sildenafil Citrate Alone: A Pilot Study

Erectile dysfunction (ED) is a complex condition wherein men with minimal organic ED may develop a variable degree of psychogenic component sufficient to reduce the efficacy of medical management. A combination of trazodone with sildenafil has been used to overcome both organic as well as psychogenic components, thus improving the results of medical management. To evaluate the efficacy of combination of trazodone with sildenafil citrate in treatment of ED in men with initial failure to sildenafil citrate alone. The symptoms of ED were evaluated using the Erectile Dysfunction Intensity Scale (EDIS) before and after the treatment. Eighteen men with ED who initially failed to respond to sildenafil citrate alone were enrolled in the study between February 2004 and December 2004. All these men were given a priming dose of trazodone for a 2-week period before giving them sildenafil citrate. Of the 18 men, 12 responded favorably to the above treatment and continued to enjoy good sexual activity while on trazodone and sildenafil. The score on EDIS improved considerably in 12 (66.7%) men, marginally in two (11.1%) men, and did not improve at all in four (22.2%) men. Priming the patients with trazodone appears to be a reasonably good alternative in patients who have initial failure to oral sildenafil citrate and have been found to have no organic cause of ED. However, large double-blind studies are required to potentiate this hypothesis.

In vivo and in vitro response of corpus cavernosum to phosphodiesterase‐5 inhibition in the hypercholesterolaemic rabbit

To investigate the effects of hypercholesterolaemia (HC) on rabbit corpus cavernosa in vivo and in vitro, and evaluate the efficacy of vardenafil and sildenafil in normal and HC rabbits, as the phosphodiesterase-5 (PDE-5) inhibitors vardenafil and sildenafil are widely used for treating erectile dysfunction (ED) and most organic causes of ED are associated with vascular risk factors like HC. Male New Zealand White rabbits were randomly divided into two groups; 11 HC rabbits were fed a 2% cholesterol diet, and 12 age-matched control rabbits received a regular diet. After 12-14 weeks, erectile responses to intravenous sodium nitroprusside (SNP) and PDE-5 inhibitors were evaluated for 2 h in conscious rabbits. Penile length was measured and the area under the curve calculated. Relaxant responses of corpus cavernosal strips to electrical-field stimulation (EFS) were measured before and after exposure to PDE-5 inhibitors and the nitric oxide synthase inhibitor N'-nitro-L-arginine methyl ester. HC rabbits had a lower erectile response to SNP than controls; in both control and HC rabbits there was a greater erectile response after simultaneous exposure to SNP and vardenafil, or SNP and sildenafil. However, the responses of the HC rabbits were still significantly less than those of the controls. Corpora from control rabbits responded to EFS with greater relaxations at all frequencies, except 1 Hz. Corpora from both HC and control rabbits had greater responses to EFS after exposure to vardenafil and sildenafil; N'-nitro-L-arginine methyl ester diminished the response to EFS. There was a significantly lower in vivo and in vitro erectile response in HC rabbits than in controls; erectile function measured in conscious rabbits can be used to assess quantitatively the efficacy of different agents, e.g. sildenafil and vardenafil, in pathological animals. In addition, both agents improve in vitro responses of erectile tissue from HC rabbits to EFS.

Lower Urinary Tract Symptoms in Patients with Erectile Dysfunction: Is There a Vascular Association?

Objective: To assess if there is an underlying vascular association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Materials and methods: A total of 374 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. Assessments for penile vasculature using color Doppler ultrasonography and rigidometer were performed. All patients were also screened for LUTS using the International Prostate Symptoms Score. All patients underwent routine laboratory investigation, plus total testosterone and prolactin assessment. Results: Mean age ± SD was 54.4 ± 8.9 years with an age range of 28–84 years. Eighty-five percent of the patients had organic causes of ED. Of the patients, 80.7% had different degrees of LUTS. There was a significant association between presence of LUTS and: arteriogenic and neurogenic causes of ED, poor response to intracorporeal injection, poor rigidity in the rigidometer, and low peak systolic velocity of the cavernosal arteries ( p < 0.05 for each). No significant association was found between presence of LUTS and increasing values of end diastolic velocity or decreasing values of resistive index of the cavernosal arteries ( p > 0.05 for each). There was a significant association between the higher degrees of LUTS and the decreasing values of peak systolic velocity ( p < 0.05). Conclusions: This study demonstrated that reduced peak systolic velocity of the cavernous artery does associate with LUTS in patients with erectile dysfunction. Further studies are warranted to address the underlying vascular mechanisms of ED in patients with LUTS.

Clinical application of prognostic factors for patients with organic causes of erectile dysfunction on 100 mg of sildenafil citrate

There are still no clinical predictive factors to determine the response rate of erectile dysfunction (ED) patients to sildenefil citrate. The aim of the present study is to evaluate and stratify the risk factors and attempted to determine the prognostic factors in clinical practice to predict the response rate. This is important in improving cost effectiveness and avoiding side-effects. This is an open label prospective study including patients attending the andrology clinic in Tan Tock Seng Hospital, Singapore, over 2 years. The patients were evaluated and investigated for possible underlying causes and ED severity was assessed by five-items of the International Index of Erectile Function questionnaire (IIEF-5), together with the duration, degree and rigidity of erection. Psychogenic causes were excluded with a minimal follow up of 6 months. All patients were placed on 100 mg of sildenafil citrate and were reassessed at the end of 6 months. Logistic regression with univariate and multivariate was used as the method of statistical analysis. A total of 232 patients were in the cohort. The overall response rate was 43%, with the best response rate in veno-occlusive cases and the worst responses from neurogenic causes. Age, smoking, diabetes mellitus, hypertension, hyperlipidemia, pretreatment IIEF-5 score, interval to achieve erection and duration of erection were significant in univariate analysis, but only age, smoking and IIEF-5 score were significant in multivariate analysis. With a combination of these factors, a table was formed to determine the possible response rate in clinical practice. This will assist physicians in selecting patients with potentially favorable responses and avoid side-effects and an unnecessary wastage of time and cost. Possible factors could be determined and used clinically to predict the response rate to sildenafil citrate.

Erectile dysfunction in heart disease patients

Atherosclerosis is a general health problem that not only affects the coronary arteries but also (in men) the penile arteries, thus contributing to organic causes of erectile dysfunction (ED) in heart disease patients. These organic causes are intertwined with psychological and pharmacological causes because medication prescribed for heart disease patients may also cause ED. The incidence of ED after myocardial infarction ranges from 38 to 78%. As sexual intercourse involves physical exertion, the medical history, ventricular function determined through echocardiography, and stress testing are used to classify patients into various groups where coital activity represents a greater or lesser cardiovascular risk. The energy requirements for intercourse are not high, ranging from 3.7 metabolic equivalents (METs) of energy expenditure at resting state during the preorgasmic phase to 5 METs during orgasm. The Bruce protocol for exercise stress testing is a six-stage protocol with changes in the slope and speed of the treadmill. As a general rule, a patient who completes the first two stages of the Bruce protocol has a functional capacity greater than 7 METs, which is considered sufficient for sexual intercourse. The physician or cardiologist concerned should institute first-line treatment with oral drugs according to the indications listed below. If sexual activity is not contraindicated, the treatment of choice for ED in heart disease patients is oral therapy with sildenafil, except in those cases in which its use is contraindicated. Specific recommendations are discussed.

Screening for ischemic heart disease in patients with erectile dysfunction: Role of penile Doppler ultrasonography

Objectives To assess the role of measuring cavernosal artery blood flow as a screening tool for ischemic heart disease in patients with erectile dysfunction (ED). Methods A total of 303 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. The penile vasculature was assessed using color Doppler ultrasonography and the Digital Inflection Rigidometer. All patients were referred to a cardiologist for evaluation of ischemic heart disease (IHD). All patients underwent routine laboratory investigations, plus total testosterone and prolactin assessments. Results Seventy-six percent of the patients had organic causes of ED. Of the 303 patients, 31.4% had different degrees of IHD. A statistically significant association was found between the presence of IHD and arteriogenic causes of ED, a poor response to intracorporal injection, poor rigidity in the Digital Inflection Rigidometer, and low peak systolic velocity (PSV) in the cavernosal arteries ( P <0.05 for each). No statistically significant association was found between the presence of IHD and increasing end-diastolic velocity values or decreasing resistive index in the cavernosal arteries ( P >0.05 for each). A statistically significant association was found between a higher grade of IHD and a decreasing PSV value ( P <0.05). Conclusions The results of this study established that a reduced PSV of the cavernous artery is associated with IHD. Determining the PSV could be a reliable screening tool for the detection of IHD in patients with ED.

Cardiovascular aspects of erectile dysfunction

AbstractErectile dysfunction (ED) reflects endothelial dysfunction, which is the most common organic cause of ED. Vascular disease and/or diabetes are most frequently associated with ED with coexisting coronary artery disease a major concern. Advising on sexual activity and the treatment of ED is a management challenge but simple guidelines exist for advice in the out‐patient (or out of hospital) and in‐patient setting which allow safe and effective recommendations to be given in properly assessed diabetic patients. Copyright © 2004 John Wiley &amp; Sons, Ltd.

Characteristics of erectile dysfunction in Saudi patients.

We investigated the characteristics of erectile dysfunction (ED) in ambulatory Saudi patients. A total of 680 male patients were assessed for ED using IIEF. Patients were also interviewed for sociodemographic data, medical history and risk factors for ED. Assessment for penile vasculature using color Doppler ultrasonography and rigidometer was performed. In all, 21.4% of the patients with severe ED were <50 y and 78.6% of them were > or =50 y (P<0.001). Of the patients, 20% had psychogenic, while 80% had organic causes of ED. Of the patients, 10% had mild, 39.3% had moderate and 50.7% had severe ED. There was a significant association between increasing severity of ED and the presence of diabetes, hypertension, dyslipidemia, smoking, increased BMI, increased values of EDV, decreased values of PSV, RI and rigidometer (P<0.001 for each). Moderate to severe ED is common among Saudi patients. This study provides a quantitative estimate of the characteristics of ED in ambulatory Saudi patients.

Nitric oxide is involved in the inhibitory neurotransmission and endothelium-dependent relaxations of human small penile arteries.

1. Alteration in the flow of blood to the penis is thought to be the most frequent organic cause of erectile dysfunction or impotence. However, information concerning the penile small arteries (helicine arteries) which control blood flow between the arterial systemic circulation and the cavernous sinusoids is scarce. Therefore, the purpose of the present study was to investigate the involvement of nitric oxide, which is considered to be the main neurotransmitter in corpus cavernosum, in both the non-adrenergic non-cholinergic inhibitory neurotransmission and the endothelium-dependent responses in human penile small arteries. 2. Penile small arteries (lumen diameter 200-700 microns), which were branches of the human deep penile arteries obtained either from patients undergoing penile surgery or from organ donors, were mounted in microvascular myographs for isometric tension recording and electrical field stimulation was performed in the presence of guanethidine and atropine to block adrenergic neurotransmission and muscarinic receptors, respectively. 3. In phenylephrine-contracted penile small arteries, electrical field stimulation (0.5-32 Hz) induced frequency-dependent relaxations of both endothelium-intact and -denuded preparations. The inhibitor of nitric oxide synthase, NG-nitro-L-arginine (3 x 10(-5) mol/l), abolished the relaxations at the lowest frequencies, while slow-developing relaxations were still observed at high frequencies (16 and 32 Hz). The inhibitory effect of NG-nitro-L-arginine was reversed in the presence of L-arginine (3 x 10(-3) mol/l). Tetrodotoxin totally abolished the relaxations to electrical field stimulation. In contracted small penile arteries in the presence of NG-nitro-L-arginine, the nitrovasodilator sodium nitroprusside induced potent relaxations. 4. The endothelium-dependnet vasodilator acetylcholine induced relaxations of penile small arteries, which were only partially reduced in the presence of NG-nitro-L-arginine. In contrast, the relaxations to acetylcholine of trabecular corpus cavernosum preparations were almost abolished in the presence of NG-nitro-L-arginine. 5. The present study suggests that relaxations of human intracavernosal small penile arteries induced by non-adrenergic non-cholinergic nerve stimulation partially involve nitric oxide and also another inhibitory transmitter causing relaxations resistant to nitric oxide synthase blockade. In addition, endothelium-dependnet relaxations in human small penile arteries are mediated by both nitric oxide and a factor resistant to NG-nitro-L-arginine.