Vasculogenic Erectile Dysfunction Research Articles

Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Diabetic Patients.

The cause of erectile dysfunction (ED) in diabetic patients is complex and involves both neurogenic and vasculogenic components and is often hard to treat. To study the effect of low-intensity extracorporeal shock wave therapy (Li-ESWT) therapy on a subgroup of diabetic patients with ED who are responders (PDE5I-R) and non-responders (PDE5I-NR) to phosphodiesterase 5 inhibitors (PDE5I). Analysis of pooled data from 5 double-blind, sham-controlled trials was performed. In this sub-analysis, of 350 patients in the PDE5I-R group and with vasculogenic ED, we found 61 patients with diabetes mellitus who underwent LI-ESWT. Another 48 patients (of 53) belonged to the PDE5I-NR group. Baseline efficacy was evaluated with the International Index of Erectile Function-Erectile Function domain questionnaire (IIEF-EF) for the PDE5I-R and with Erection Hardness Score, IIEF-EF, and flow-mediated dilation technique for the PDE5I-NR. Change in the IIEF-EF score after treatment of diabetes-induced ED with Li-ESWT in the PDE5i-R group vs the PDE5i-NR group. LI-ESWT therapy was found to be effective in both subgroups of diabetic patients. Minimally clinical important difference in IIEF-EF score was achieved in 50%, 79.5%, 77.3%, and 65.9% of the subjects in the active group in after the sixth shockwave (SW) treatment evaluation (just before initiating the seventh SW session) and at 1 month, 6 months, and 12 months after the last SW treatment, respectively. The difference among the groups was significant (P < .05) after the sixth treatment and in all the follow-up periods. In the PDE5I-NR group, 55% of the active group were converted to PDE5I-5-R after LI-ESWT. The difference between the active and sham groups was statistically significant in all the tested measures (P < .001). LI-ESWT is safe and effective for the treatment of ED in PDE5I-R and PDE5I-NR groups. Spivak L, Shultz T, Appel B, etal. Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction in Diabetic Patients. Sex Med Rev 2021;9:619-627.

Determinants of Early Response to Low-Intensity Extracorporeal Shockwaves for the Treatment of Vasculogenic Erectile Dysfunction: An Open-Label, Prospective Study

The aim of this study was to expand existing literature on the effects of cardiovascular risk factors on the outcome of low-intensity extracorporeal shockwaves therapy (LIESWT), and to evaluate the role of hormone concentrations. Twenty patients with long-standing, PDE5i-resistant, vasculogenic erectile dysfunction (VED) were treated with six weekly sessions of LIESWT (9000 pulses). After a three-week break, four poor responders underwent another six weekly sessions. Rigidity score (RS) questionnaire was administered at baseline (T0), last session (T1), and three months after LIESWT (T2), while the Improvement component of the Clinical Global Impression of Change (CGIC-I) and the International Index of Erectile Function-5 (IIEF-5) questionnaires were administered at T1 and T2, and at T0 and T2, respectively. At T0 serum luteinizing hormone (LH), testosterone, sex hormone binding globulin (SHBG), calculated free testosterone, and prolactin levels were also recorded. At T1 and T2, 12/20 (60%) and 11/20 (55%) patients reached a RS ≥ 3; 16/20 (80%) and 13/20 (65%) improved their erections variably. Testosterone levels correlated positively with CGIC-I at T1. Patients < 65 years and those nonhypercholesterolemic had higher RS at T1 and T2. Age correlated negatively with RS at T1 and T2. At T0, diabetic patients had lower IIEF-5 scores, but those with RS ≥ 3 at T1 had higher IIEF-5 compared to those with RS < 3. Also, diabetes duration correlated inversely with IIEF-5 at T0. At T2, IIEF-5 improved significantly by an average of 2.8-points. We confirm safety and effectiveness of LIESWT for the treatment of VED. Age ≥ 65 years, diabetes, and hypercholesterolemia influence early and negatively the outcome of LIESWT.

Folic acid supplementation improves erectile function in patients with idiopathic vasculogenic erectile dysfunction by lowering peripheral and penile homocysteine plasma levels: a case-control study.

Erectile dysfunction (ED) has common risk factors with many cardiovascular (CV) impairments. In view of these facts, hyperhomocysteinemia (HHcys) has been postulated for involvement in endothelial dysfunction. We evaluated peripheral and penile homocysteine (Hcys) plasma levels before and after folic acid supplementation in idiopathic vasculogenic erectile dysfunction (ED) patients. This study included 50 consecutive patients and 50 consecutive healthy controls that were recruited from December 2017 to December 2018. The patients received folic acid (FA) daily for 3months and were evaluated by the abridged 5-item International Index of Erectile Function (IIEF-5) and penile duplex before and after therapy, in addition to plasma Hcys levels. Our study showed improvement in the severity of ED in our patients as all of them became mild to moderate ED after folic acid administration. Additionally, the median scores of IIEF-5 significantly increased from 6 to 14, respectively (p<0.001). Furthermore, the median peripheral and penile Hcys plasma levels (μmol/l) significantly decreased after folic acid administration as 39 patients with moderate ED and 11 patients with severe ED were 0.62, 0.34, 5.37, 0.37, respectively, became mild to moderate ED with their median peripheral and penile Hcys plasma levels became 0.19, 0.15, p<0.001, <0.001, respectively. Peripheral Hcys level correlates significantly with penile Hcys before and after folic acid administration (r: -0.06 p: 0.8, r: 0.9, p<0.001, respectively). Recently, an emerging body of evidence suggests a role for Hcys and folate in erectile function. Interestingly, our interventional study is one of the first that evaluated the effect of folic acid supplementation on HHcys where it demonstrated a significant decrease in peripheral and penile Hcys plasma levels after folic acid administration. Thus, FA should be prescribed concomitantly with phosphodiesterase type 5 inhibitors in ED patients.

Low-Intensity Shockwave Therapy (LiST) for Erectile Dysfunction: Is It Safe for Patients on Anticoagulant Medication?

IntroductionA significant percentage of men with vasculogenic erectile dysfunction (ED) use antiplatelet therapy because they have a history of cardiovascular disease. However, the safety of this novel treatment modality in patients under antiplatelet treatment has been based on anecdotal cases, and published data are lacking. The aim of this study is to examine the safety of low-intensity shockwave therapy (LiST) on a group of patients under antiplatelet therapy who were treated with LiST. MethodsA pulled data analysis, conducted from November–December 2018, including 2 randomized clinical trials conducted at an Andrology outpatient clinic is presented. The 2 trials used the same design, the same shockwaves generator, as well as the same method of delivering the energy. The LiST protocol differed between the patients regarding LiST sessions number (6, 12, or 18), sessions frequency (1, 2, or 3 sessions/wk) and energy flux density used, which was either 0.05 or 0.1 mJ/mm2. The number of 5,000 pulses/session remained unchanged. For the purpose of the current study, patients receiving anticoagulant medication at the time of treatment and follow-up period were included in this analysis. All patients had a diagnosis of vasculogenic ED. According to the study protocol, after every treatment visit, as well as at 1 and 3 months after treatment, all patients reported any side effects or complications of the treatment; physical examination of the penis was performed before and after each treatment session, as well as at follow-up visits at 1 and 3 months. Penile ultrasonography was performed at baseline, as well as at 3 months’ follow-up, at the same time with triplex ultrasonography by the same investigator. Results138 patients were included in the 2 trials, whereas 135 (98%) of them finished the 3 months follow-up. 35 (25.3%) of them were under anticoagulant/antiplatelet medication during LiST. No bleeding events or any other side effects were reported. Strengths & LimitationsThe main strength of this article is that it is the first report on the safety of LiST on the specific group of cardiovascular patients with ED under anticoagulant/antiplatelet therapy. However, it is a pulled data analysis, based on 2 randomized studies, which did not have safety of LiST as a primary outcome. ConclusionLiST seems to be a safe and well-tolerated treatment option for vasculogenic ED in patients on antiplatelet medication.Kalyvianakis D, Memmos D, Mykoniatis I, et al. Low-Intensity Shockwave Therapy (LiST) for Erectile Dysfunction: Is It Safe for Patients on Anticoagulant Medication? J Sex Med 2019;16:1478–1480.

Penile Reinnervation Surgery: A Comprehensive Review of the Literature.

Modern approaches to erectile dysfunction (ED) often entail the use of multimodal medical therapy and surgery; however, with recent advances in microsurgery, new options may exist for patients suffering from ED. This comprehensive review of the literature serves to reevaluate anatomical and physiological principles that mediate erection to improve understanding for reconstructive surgeons hoping to offer new interventions. A search strategy for this review was agreed upon by all authors. Articles were divided into 2 categories - primary and secondary. Primary articles were defined as those in which the anatomy of the pelvis and/or perineum was the primary focus of the article, whereas secondary did not directly focus on anatomic considerations. Select historical texts and textbook chapters were also included to provide well established and critical anatomical evidence for this review. Several approaches may be used to restore nerve function to treat neurogenic and vasculogenic ED. Somatic sensory loss can be treated by either direct neurorrhaphy or neuroplasty in the location of disruption. Microvascular techniques also exist to improve flow or to repair small vessels injured in the pelvis. Classical approaches to impotence include vein stripping to reduce venous outflow or direct vascularization to improve inflow. Postradical prostatectomy ED has been demonstrated to improve with microsurgical interventions. In the coming years, innovation will continue and collaboration between plastic surgeons and urologists will allow us to tackle this common and difficult problem.

Endovascular Therapy for Vasculogenic Erectile Dysfunction: A Systematic Review and Meta-Analysis of Arterial and Venous Therapies

PurposeTo systematically review and perform a meta-analysis on the safety and efficacy of endovascular therapy in the treatment of the two most common etiologies of vasculogenic erectile dysfunction (ED): veno-occlusive dysfunction (VOD) and arterial insufficiency (AI). Materials and MethodsPubMed, Web of Science, ScienceDirect, and Scopus databases were searched for published English literature regarding endovascular ED treatments. Case series (n ≥ 3) were included. Multiple data points were obtained, including demographic data, etiology, diagnosis method, imaging studies, treatment approach, technical success, clinical success, complications, and follow-up. ResultsSixteen relevant articles were obtained and a total of 212 patients with VOD and 162 with AI were identified. The VOD cohort were treated either percutaneously (60.4%; n = 128) or after surgical exposure of the deep dorsal vein (33.5%, n = 71), or it was unspecified (6.1%; n = 13). The most common embolic used was n-butyl cyanoacrylate (51.9%; n = 109). Meta-analysis found an overall clinical success rate of 59.8% in VOD patients. Complications occurred in 5.2% of patients (n = 11), with 9 considered to be mild and 2 considered to be severe. The AI cohort contained 162 patients most commonly treated via stenting of the internal pudendal artery (40.1%; n = 65). Meta-analysis found an overall clinical success rate of 63.2% in AI patients. Complications occurred in 4.9% of patients (n = 8), with 4 considered to be mild and 4 considered to be severe. ConclusionsEndovascular therapy for medically refractory ED is safe and may provide a treatment alternative to more invasive surgical management; however, conclusions are limited by the heterogeneity of clinical success definitions among the included studies.

PO-01-102 Evaluation of linear shock wave therapy in patients with vasculogenic erectile dysfunction in the Slovenian population

Linear shock wave therapy (LSWT) has been proposed as an effective treatment option for vasculogenic erectile dysfunction (ED). Our aim was to assess the effectiveness of treatment among the Slovenian male population. With LSWT we treated 88 patients with clinically determinated vascular ED and no history of prostate surgery, androgen therapy, pelvic radiation, haematologic disease, penile curvation or venous ED. Their average age was 61 (34-93) years. Firstly, the patients were examined and the International index of erectile function (IIEF-15), Sexual Encounter Profile (SEP) and Global Assessment Questions (GAQ) scores were assessed. After that, they underwent 4 weekly LSWT sessions with RENOVA. We applied 1600 shockwaves on each crura and 900 shockwaves on each cavernosa with an energy intensity of 0.09 mJ/mm2. Each session lasted approximately 20 minutes. Currently, we are evaluating the IIEF-15, SEP and GAQ scores, which were collected before the treatment, 1 month and 3 months after the last session.

The association of Intron 4 VNTR and Glu298Asp polymorphisms of the nitric oxide synthetase 3 gene and vasculogenic erectile dysfunction in Turkish men

ABSTRACTSeveral studies have focused on the impaired role of endothelial nitric oxide synthase (NOS3) gene polymorphism and its association to erectile dysfunction (ED). However, currently controversial results have been reported due to their significant heterogeneity. The present study aimed to assess the genotypic distribution and the allelic frequency of Intron 4 VNTR and Glu298Asp gene polymorphisms in vasculogenic ED patients compared to healthy controls of a specific region of Turkey. A total of 75 patients with ED (median age: 56, IQR:10.5) and 75 healthy controls (median age: 56, IQR:10.5) were prospectively analyzed. All subjects were equally evaluated by the same physician with detailed history-taking, physical examination, International Index of Erectile Function (IIEF) questionnaire, and blood tests (incl. glucose, testosterone, triglyceride and total cholesterol level). Those with an IIEF score under 26 were considered to have ED, by classifying them according to their scores as mild (22–25), moderate (11–21) and severe (1–10) ED. Color doppler ultrasonography was carried out in patients with an IIEF score <22. Hypertension, diabetes mellitus, coronary artery disease, and smoking status were significantly associated with the ED group compared to control subjects with p values of <0.001, <0.001, 0.002 and <0.001, respectively. Overall genotype frequencies was 47 (31%) a/a, 22 (15%) a/b, 82 (55%) b/b for Intron 4 VNTR and 56 (37%) GG, 78 (52%) GT, 16 (11%) TT for the Glu298Asp polymorphism. The frequencies of Intron 4 VNTR a/a allele and Glu298Asp GT allele were associated with severe ED, while a/b and TT were associated with moderate or mild, and b/b and GG were associated with no ED. In contrast to Glu298Asp, statistically significant differences in genotypic frequencies of Intron 4 VNTR gene polymorphism between ED and control subjects was established.Abbreviations: NO: nitric oxide, NOS: nitric oxide synthase, NOS3: endothelial nitric oxide synthase, NOS2: inducible nitric oxide synthase, NOS1: neuronal nitric oxide synthase, HT: hypertension, DM: diabetes mellitus, CAD: coronary artery disease, ED: erectile dysfunction, IIEF: international index of erectile function, VNTR: variable number of tandem repeats, CDU: color doppler ultrasonography, PCR: polymerase chain reaction.

PD43-10 CURRENT CUT-OFF VALUE FOR PEAK SYSTOLIC VELOCITY AND RESISTANCE INDEX UNDER PENILE DOPPLER ULTRASOUND NOT ADEQUATE ENOUGH FOR PATIENT WITH ERECTILE DYSFUNCTION

INTRODUCTION AND OBJECTIVES:Penile Doppler ultrasound is a frequently-utilized tool for diagnosing vasculogenic erectile dysfunction (ED). Current guideline from European Urology suggested a cut-of...

189 Electronic Cigarette Smoke and Western Diet in Erectile Dysfunction: Histological Changes in Mice Corpora Cavernosa

Although many studies have shown that byproducts of tobacco smoke and low-density lipoprotein induce oxidative stress on vascular endothelium leading to corporal smooth cell damage making smoking and dyslipidemia known modifiable risk factors of vasculogenic erectile dysfunction (ED), research on the effects of electronic cigarette smoke (ECS) and diet in ED is sparse. To investigate the histological changes in corpus cavernosal tissue in the animal model using ApoE-/- atherosclerotic mice exposed to electronic cigarette smoke and consistently fed a diet high in fat and refined grains resembling the Western Diet (WD). Ten 8-week old Apo E -/- mice were divided into two groups consisting of 5 mice each. The control group was fed a WD containing 40% fat, 43% carbohydrate, and 17% protein. The electronic cigarette group was fed a daily WD and exposed ECS (WD+ECS) consisting of vaporized nicotine, propylene glycol, vegetable glycerin, and distilled water via a free-moving exposure chamber. Animals were euthanized at 12 weeks after treatment. The mice penises were isolated, fixed in formalin and processed for paraffin embedded sections. As a marker of fibrosis, sections were stained with Masson Trichrome for determination of smooth muscle (SMC)/collagen ratio. SMC proliferation was determined by Proliferating Cell Nuclear Antigen (PCNA) staining. Cell counts were determined by Image J (U. S. National Institutes of Health, Bethesda, Maryland, USA, https://imagej.nih.gov/ij/).

Comparative Study between Intracavernosal Injection of Botulinum Toxin type A [50 and 100 unit], Efficacy and Durability in the Treatment of Vascular Erectile Dysfunction

Evidence has been arising suggesting that Botulinum toxin type A [BTX-A] injections can relax smooth muscles fibers in the treatment of obesity and Detrusor muscle over-activity, similar effect on cavernosal smooth muscles would help in the treatment of erectile dysfunction [ED] resistant to oral and intracavernous injection [ICI] therapy, thus it could be an alternative option for failed medical and other injectable therapy.. to compare safety, efficacy and durability of different doses of BTX-A [50 and 100 Unit] in the treatment of Vasculogenic Erectile Dysfunction after failure of other ICI therapy.. Forty-five patients with Vasculogenic erectile dysfunction who are failed treatment with non-surgical options were included at this study after elimination of all patients who are not matching eligible criteria or not complete the follow up program. The patients were randomized into 3equal groups, each group include 15 patients. Group [I] injected with 100U BTX-A, group [II] injected with 50U BTX-A and Control group injected with normal saline. All groups underwent follow up at 2 weeks, 3 months and 6 months intervals after injection, for assessment of all subjective data as, IIEF-5 Questionnaire [SHIM score], Erection hardness score [EHS], Sexual encounter profile [SEP 2 and 3], Global assessment score[ GAS 2 and 3]. Also assessment of objective data by penile Doppler details.. Although 25 patients [55.6%] respond to BTX-A injection subjectively and objectively {13 patients [28.9%] in group [I] and 12 patients [26.7%] in group [II]}, but this impressive effect was not durable especially in group [II] as 9 patients [20%] show lost effect through complete follow up till 6 month in comparison to 5 patients [11.1%] in group [I] show same lost effect. Besides that, 5 patients [11.1 %] not responding to this treatment option {two patients [4.4%] in group [I] and 3 patients [6.7%] in group [II], also patients in Control group show non-significant subjective improvement. BTX-A could be a potential but not durable therapy for erectile dysfunction, as BTX-A [50 and 100 Unite] show almost same efficacy but, with complete follow up through 6 months, BTX-A 100U is more durable than 50U

04:21 PM Abstract No. 32 Endovascular therapy for vasculogenic erectile dysfunction: a systematic review of arterial and venous therapies

04:21 PM Abstract No. 32 Endovascular therapy for vasculogenic erectile dysfunction: a systematic review of arterial and venous therapies

Platelet indices and erectile dysfunction: A systematic review and meta-analysis.

Elevated platelet levels have been postulated to be associated with cardiovascular diseases, conditions closely linked to erectile dysfunction (ED). The current systematic review and meta-analysis was performed to assess the platelet indices, which including platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW) in subjects with ED compared to controls in an attempt to clarify the possible role of platelet indices in the pathogenesis of ED. We initially screened the candidate studies observing the possible association between platelet indices and ED following literature search of database Cochrane Library, PubMed, EMBASE and MEDLINE and therefore included the studies based on the pre-defined inclusion and exclusion criteria. Two independent investigators extracted the related information on article data and outcome measures from the qualified studies, and a meta-analysis was therefore performed using Stata 12.0 software. Subgroup analyses were conducted by the different ED aetiology obtained from the eligible studies. The standard mean difference (SMD) and the corresponding 95% confidence intervals (95% CIs) were applied to estimate the outcome measures. A total of 14 articles were qualified in our meta-analysis with a total of 1595 cases and 987 controls included. Pooled estimate was in favour of increased MPV levels in subjects with ED with a SMD of 0.651fl, 95% CI 0.567-0.735, p=0.000. Subgroup analysis showed that vasculogenic ED had a higher MPV levels than controls as well (SMD [95% CI]=1.026 [0.823-1.228], p=0.000). However, pooled analysis based on PLT and PDW levels has produced inconsistent results and not strong evidence on platelet level and ED correlation. In conclusion, vasculogenic ED patients had a higher MPV level in our study. However, the results need further interpretation with caution and more high-quality studies are warranted.

Low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction following radical prostatectomy: a critical review.

Low-intensity extracorporeal shockwave therapy (LI-ESWT) to the penis has recently emerged as novel therapeutic option in the treatment of erectile dysfunction (ED). Randomized-controlled studies investigating the effect of this new treatment modality revealed promising results in men with vasculogenic ED. However, the efficacy of LI-ESWT in men who develop ED following radical prostatectomy (RP) remains obscure due to the exclusion of this group in nearly all clinical trials. In this review, the authors synthesize the findings from available preclinical and clinical studies that examine the potential utility of LI-ESWT in men with post-RP ED.

Carotid artery intima-media thickness can predict the response of patients with erectile dysfunction to phosphodiesterase 5 inhibitors.

This study investigated the role of carotid artery intima-media thickness (IMT) as a morphological marker of the response of vasculogenic erectile dysfunction (ED) patients to tadalafil, one of the phosphodiesterase 5 inhibitor (PDE5-I). Through March-December 2016, 51 men with vasculogenic ED aged over 30 years were enrolled in this prospective study. Vasculogenic ED was accepted as a normal testosterone level, with penile colour Doppler ultrasonography showing arteriogenic ED, venogenic ED or mixed arteriogenic and venogenic ED. All patients underwent biochemical and hormonal blood tests, ultrasonographic evaluation of the common carotid artery (CCA) IMT and penile colour Doppler ultrasonography. On-demand tadalafil (10 mg or 20 mg in cases of a non-response to 10 mg) was administered to each patient for 2 months. ED was assessed using the short form of International Index of Erectile Function (IIEF-5) before and after the drug therapy. According to the patients' responses to the medication, they were grouped as non-responders or responders. Thirty-one of the 51 patients responded to tadalafil. The mean CCA IMT of the non-responders and responders was 0.9 ± 0.2 mm and 0.6 ± 0.2 mm, respectively (P = 0.000). The IMT of 90% of the non-responders was >0.67 mm, whereas it was >0.67 mm in 40% of the responders. The data were analysed using the Kolmogorov-Smirnov test, Chi-square test, t-test, Mann-Whitney U test and receiver operator characteristic (ROC) curves. Measurement of CCA IMT may offer an alternative and simple method to predict the response of vasculogenic ED patients to PDE5-Is.

Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials.

The efficacy of low intensity extracorporeal shock wave therapy (LI-ESWT) for erectile dysfunction (ED) has received hard criticism and recently published meta-analyses were not able to provide further insights, nor specific recommendations. The aim of this systematic review and meta-analysis is to evaluate the efficacy of LI-ESWT for ED, identify the ideal treatment population and treatment protocol, and provide recommendations for future research in the field. A systematic research for relevant clinical studies published from January 2010 to September 2018 was performed, using the following databases: Medline, Embase, The Cochrane Library, Scopus, and Web of Science. Only clinical studies that investigated the efficacy of LI-ESWT for ED only, and reported primary outcomes using IIEF-EF scores/questionnaires were included. Both, randomised controlled trials (RCTs) and cohort studies were included, but the meta-analysis was performed only for sham-controlled RCTs. Ten RCTs including 873 patients were selected for the meta-analysis. Pooling data of these studies showed that LI-ESWT could significantly improve erectile function in men with ED regarding both patient-subjective outcomes (IIEF-EF: +3.97; 95% CI [2.09-5.84]; p < 0.0001, EHS ≥ 3: OR: 4.35; 95% CI [1.82-10.37]; p = 0.0009) and patient-objective outcomes (peak systolic velocity: +4.12; 95% CI [2.30-5.94]; p < 0.00001). In conclusion, the present meta-analysis provided results showing that LI-ESWT significantly improves erectile function in patients with vasculogenic ED.

ERECTILE DYSFUNCTION AND CAVERNOUS VENO-OCCLUSIVE DISEASE

GoalTo provide a state-of-the-art literature review on veno-occlusive diseases as a pathomechanism of vasculogenic erectile dysfunction (ED).MethodsA comprehensive systematic literature search was conducted followed by sorting, review, and summarizing.&#x0D; ResultsThe systematic review of the literature reveals a significant number of recent studies dealing with new minimally invasive methods to provide a potential solution of caverno-venous leakage. Even the long-term results reported demonstrate considerable improvement of ED caused by this condition. Furthermore, 3-D computed tomography cavernosography (CT-cavernosography) is a new technology, which can provide high-resolution images of venous drainage from any angle and shows to be very helpful for both the diagnosis of corporal veno-occlusive dysfunction and the anatomical study of the human penile venous system. The application of this technology may also lead to better strategies in venous leak treatment. Over 30 published studies were found in the literature with good results after caverno-venous leak treatment. Altogether, 13 comparable studies including 538 patients were found, in which a mean short-term success rate of almost 80% and a mean long-term success rate of up to 74% was achieved. None of the studies described major complications.ConclusionED is an increasingly important issue, especially in young men. Whereas the current treatment strategies are mostly focused on older men, young patients are seeking more a longer lasting or more definitive solutions, rather than a lifelong medical treatment. Various chronic disorders have been reported to be associated with elevated rates of ED including depression, diabetes, and cardiovascular and neurological disease in older men. Properly selected cases of young men may benefit from treatment of caverno-venous leak treatment. The current strategy in the treatment of ED in young men may be reconsidered.

The impact of interferon therapy on the sexual function of hepatitis C male patients

Objective To evaluate the impact of interferon therapy on male sexual function. Patients and methods One hundred hepatitis C patients were included in the study. Fifty two patients were receiving interferon and 48 patients were not receiving interferon. All participants underwent history taking including International Index of Erectile Function (IIEF-5) score, general and local examination, assessment of hormonal profile, and pharmacopenile duplex Doppler ultrasonography. Results The IIEF-5 score of the noninterferon-treated group (18 ± 6.5) was significantly higher than the interferon-treated group (12 ± 4.5) (P = 0.022). Forty (76.9%) patients on interferon reported low sexual desire compared with 22 (45.8%) patients of noninterferon-treated group (P = 0.001). Total testosterone among interferon-treated patients (188 ± 0.32 ng/dl) was significantly lower than noninterferon-treated patients (270 ± 0.52 ng/dl) (P = 0.001). Similarly, free testosterone level among interferon-treated patients (3 ± 0.22 ng/dl) was significantly lower than noninterferon-treated group (7 ± 2.3 ng/dl) (P = 0.05). Estradiol levels among interferon-treated patients (80 ± 3.3 pg/ml) were significantly higher than noninterferon-treated patients (58 ± 2.3 pg/ml) (P = 0.01). However, prolactin level showed no significant difference between the interferon-treated (13 ± 1.3 ng/ml) and the noninterferon-treated groups (12 ± 1.5 ng/ml) (P = 0.59). Thirty eight (73%) patients on interferon showed vasculogenic erectile dysfunction compared with 32 (66.7%) patients not receiving interferon (P = 0.11). Twenty two (42.2%) patients on interferon showed veno-occlusive dysfunction which was significantly higher than noninterferon group (16.6%) (P = 0.03). Eighteen (37.5%) patients of the noninterferon group showed mixed vasculogenic erectile dysfunction compared with eight (15.4%) patients on interferon (P = 0.05). Conclusion Interferon had negative impact on libido, IIEF-5 score, and hormonal profile but did not affect penile hemodynamics.

Penile doppler ultrasound predicts cardiovascular events in men with erectile dysfunction.

Traditional risk factors used to assess cardiovascular risk miss a significant population who are indeed at risk for future cardiac events. Erectile dysfunction (ED) is an emerging marker for future cardiovascular disease (CVD) and major adverse cardiovascular events (MACE), especially in young and middle-aged men with vasculogenic ED. Cavernous arteries morphological alterations at penile colour doppler ultrasound (P-CDU) are used to find a vasculogenic ED. We investigated the possible relationship between cavernous arteries morphological alterations at P-CDU assessment and future MACE. We conducted a retrospective cohort study involving 300 ED patients, aged 35-65years (mean age 54.1±7.1), with a follow-up period of 10years. Patients underwent vascular evaluation including P-CDU, colour doppler ultrasound of the carotid and lower limbs arteries. At baseline data for glucose metabolism, lipid profile, hypertension and hormonal status were collected. During the follow-up period, the occurrence of MACE was evaluated. We found a strong association between cavernous arteries morphological alterations and CVD with a threefold increased risk of future MACE in comparison to patients with healthy cavernous arteries (RR 3.2, 95% CI 1.17-8.78). This association remained statistically significant after adjustment for CV risk factors (age, glycaemia, total cholesterol, hypertension and smoke). Morphological alterations of cavernous arteries are independently associated with an increased risk of future MACE. These data contribute to the formulation of the hypothesis that cavernous artery pathology at P-CDU is related to MACE.

The Role of Revascularization of the Profunda Femoris Artery in Vasculogenic Impotence

Erectile dysfunction is a common disorder, but the underlying cause is difficult to clarify because the organic (endocrine, neurogenic, vasculogenic and iatrogenic) and psychological components are mixed. Vasculogenic impotence, due to penile vascular insufficiency, is a common symptom in patients with aortoiliac occlusive disease (Leriche’s syndrome).The aim of this clinical study was to investigate the hypothesis that revascularization of the profunda femoris artery in Leriche’s syndrome offers good results in vasculogenic erectile dysfunction. We investigated 22 men aged 50–65 years (mean 57.5 years) with vasculogenic impotence due to Leriche’s syndrome. Exclusion criteria were: age >70 years, comorbidities, such as diabetes mellitus (DM), heart failure, HIV, history of perineal trauma and medication associated with erectile dysfunction (i.e., antidepressants, anxiolytics, antiandrogenics, anticholinergics). After clinical examination, measurement was made of the angle brachial pressure index (ABPI) and the penis brachial pressure index (PBPI) with duplex ultrasonography (U/S). All the patients underwent vascular imaging: 15 digital subtraction angiography (DSA) and 7 computed tomography angiography (CTA). Psychological investigation was carried out and the papaverine test was performed to exclude other causes of impotence. The patients underwent aorto-bifemoral bypass, with profundoplasty, if needed, and were followed for one year after operation with clinical examination and measurement of the ABPI and PBPI with duplex U/S. Preoperatively, all the patients reported absence of erectile function, with inability to achieve an erection of sufficient rigidity. Clinical examination revealed absence of pulses to peripheral arteries beyond the femoral arteries and absence of bruits in the iliac arteries. The ABPI ranged between 0.35 and 0.45 (normal: 1) and the PBPI between 0.2 and 0.32 (normal: 0.75). Aorto-bifemoral reconstruction (Y-Graft) with profundoplasty, if required, was performed on all patients. In 4 patients (group I) the peripheral arteries (common, profunda and superficial femoral artery) were not affected by atherosclerotic disease and profundoplasty was not required. In 18 patients (group II) profundoplasty was necessary because of atherosclerotic occlusion of the superficial femoral arteries and stenosis of the profunda artery. Postoperatively, in group I the ABPI became normal and the PBPI ranged between 0.5 and 0.6. In group II the ABPI ranged between 0.6 and 0.75 and the PBPI between 0.48 and 0.55. During the first month of the postoperative period 14 patients (4 from group I and 10 from group II) had normal erectile function (63.6 %) and during the late postoperative period (3-6 months of follow up) 5 more patients (2 from group I and 3 from group II) had improvement of the erectile function (22.7 %). No significant clinical improvement was observed in the other 3 patients (13.6 %). In patients with Leriche’s syndrome, revascularization of the profunda femoris artery (profundoplasty) ameliorates vasculogenic impotence through the improvement of the pelvic blood flow via the collateral circulation.