Treatment of endocrinologic male sexual dysfunction

Erectile dysfunction affects 20 million to 30 million men in the United States, and it has been reported that a significant number of impotent men (2.1% to 23%) have subnormal serum testosterone levels. A decline in serum levels of testosterone accompanies normal aging in men; however, the pathophysiological and clinical consequences of this decline are unknown. Appropriate hormonal therapy for men with hypogonadism requires an understanding of the normal physiologic regulation of the testes and the pathophysiology of underlying testicular dysfunction. This article reviews those mechanisms.

Diabetes, hypertension and erectile dysfunction

Diabetes mellitus (DM) and hypertension are independent risk factors for erectile dysfunction (ED), macrovascular disease and microangiopathy. ED is very common among diabetic patients. Men with DM have ED at an earlier age and with a significantly higher prevalence (as high as 75%). The prevalence of DM also tends to be higher in patients with Peyronie's disease. DM impairs neurogenic and endothelium-mediated relaxation of penile smooth muscle. It is impossible to separate DM from hypertension and from the other vascular risk factors. Good glycaemic and hypertension control in diabetics is very important since these factors increase the risk of both microvascular and macrovascular complications, possibly including ED.

Sildenafil: a urologist's view

Erectile dysfunction (ED) is a common problem with a multifactorial aetiology. The treatment of ED has been revolutionised by the introduction of intracavernosal injections some two decades ago. However, the recent development of the orally-administered drug sildenafil (Viagra) has had a major impact on the treatment of ED. We discuss the trials with sildenafil with special reference to cardiovascular risk factors associated with ED.

A new surrogate variable for erectile dysfunction status in the Massachusetts male aging study

Erectile dysfunction (ED) is the subject of a vast clinical literature, but little information has been gathered from random samples of the general public. The Massachusetts Male Aging Study (MMAS) addressed this important aspect of men's health. The MMAS was conducted in two waves, with baseline data collection in 1987-1989 and follow-up in 1995-1997. Subsequent to the baseline MMAS survey, a consensus developed that subjective measures are optimal for defining ED. Unfortunately, the baseline questionnaire did not ask subjects directly about their erectile functioning. Thus, we previously assigned the MMAS subjects a degree of impotence at baseline using a series of related questions, employing a discriminant formula constructed from a separate sample of urology clinic patients. At follow-up the men classified themselves directly in addition to answering the original series of related questions. In the present article, we report the results of a new discriminant function, based on the MMAS men at follow-up. We also compare the two methods and discuss our reasons for preferring the internally calibrated method.

Cigarette smoking, hypertension and erectile dysfunction

Smoking is associated with an increased risk of developing erectile dysfunction (ED). For example, in the Massachusetts Male Aging Study (MMAS), cigarette smoking amplified the risk of ED associated with other risk factors (e.g. hypertension, diabetes and dyslipidaemia) or with ageing. At the molecular level, several changes associated with smoking have been documented in man and experimental models. These changes could contribute to the pathogenesis of ED. Furthermore, studies performed in dogs demonstrated a smoking-related reduction in arterial flow and venous restriction. Similarly, impaired penile flow has been documented in men who smoke. Cigarette smoking also interferes with the effectiveness of intracavernous papaverine and PGEI. Quitting is the 'first-line' therapy of ED and one of the most important measures for the prevention of atherosclerosis.

Economic cost of male erectile dysfunction using a decision analytic model: for a hypothetical managed-care plan of 100,000 members

OBJECTIVE

This paper examined the economic cost of male erectile dysfunction (ED) for a hypothetical managed-care (MC) model.

DESIGN AND SETTING

A prevalence-based cost-of-illness approach was used to estimate the direct medical cost for ED treatment. A treatment plan algorithm was developed from a MC perspective to model the initial treatment selection of various patient groups [vacuum erection device, intracavernosal injection (ICI) therapy, transurethral alprostadil suppository, sildenafil, testosterone replacement therapy, penile prosthesis] and their therapy outcomes during a 3-year period. Overall cost was based on 1998 US dollars. Total direct medical cost of ED considered in this model included the cost of initial physician consultation and evaluation, the cost incurred by patients from various treatment groups (pharmacological and surgical options), as well as the cost related to patients' follow-up for treatment within the 3-year period. Consideration for therapy switches made by patients who failed initial therapy was included as part of the clinical assumptions for this model. Treatment response and expected outcomes (dropouts) were considered for the various treatment options.

PARTICIPANTS

A total of 100,000 enrolled members were included in the study.

MAIN OUTCOME MEASURES AND RESULTS

The total cost of ED was $US3,204,792 for the 3-year period in the hypothetical MC plan. The treatment portion accounted for approximately 80% of the total cost while the cost of medical services and diagnostic tests were minimal in comparison. The 3 year total cost of nonsurgical treatment was $US2,473,045. Costs associated with each treatment alternative were $US81,866 (testosterone transdermal patch), $US51,930 (vacuum erection device), $US384,624 (ICI therapy), $US226,483 (transurethral alprostadil suppository) and $US1,728,142 (sildenafil citrate). Results from the model showed a noticeable trend of decreasing cost patterns over time and reflected the attrition observed for many of the standard medical therapies for ED.

CONCLUSIONS

Sildenafil and the vacuum erection device should be considered as first-line management strategies for ED whereas ICI therapy, transurethral alprostadil suppository and penile prosthesis implant should be reserved for second- or third-line therapy. Because costs associated with switches related to successive treatment failures can be high, treatment considerations should, therefore, focus on achieving long term patient satisfaction. The patient's preferred treatment choice, using goal-directed therapy during the initial consultation and evaluation visit, should be used.

Frequency and determinants of erectile dysfunction in Italy

OBJECTIVE

To analyze the prevalence and risk factors for erectile dysfunction (ED) in Italy in a cross-sectional study.

METHODS

Eligible for the study were men aged 18 years or more, randomly identified by 143 general practitioners among their registered patients during the period January 1996 to February 1997. ED was defined as the impossibility to achieve and maintain an erection sufficient for satisfactory sexual performance.

RESULTS

Of the 2, 010 men interviewed, 257 (12.8%) reported ED. The prevalence increased with age, from 2% in men aged 18-39 to 48% in those >70 years (tested for trend, p = 0.0001). A history of cardiopathy, diabetes, hypertension, neuropathy, thrombotic/hemorrhagic stroke, peripheral vascular disorders, pelvic/medullary injury and pelvic surgery/radiation all increased the risk of ED. The association of hypertension and diabetes tends to increase the risk of ED. In comparison with nondiabetic and nonhypertensive men, the odds ratio (OR) was 1.4 (95% confidence interval (CI), 0.7-3.2) for hypertensive men without diabetes, 4.6 (95% CI, 1.6-13.7) for diabetic men without hypertension and 8.1 (95% CI, 1.2-55.0) for men with diabetes and hypertension. In comparison with never smokers, the OR of ED was 1.7 (95% CI, 1.2-2.4) for current smokers and 1.6 (95% CI, 1.1-2.3) for ex-smokers and increased with duration of the habit.

CONCLUSIONS

The study offers a quantitative estimate of the prevalence of ED and of its main risk factors in Italian men.

Erectile dysfunction and lipid disorders

Epidemiological studies have shown that elevated serum cholesterol and reduced high density lipoprotein (HDL) cholesterol levels are associated with an increased risk of erectile dysfunction (ED). This is another example of the link between ED and atherosclerosis. Whether correcting a dyslipidaemic profile will result in a reduced risk of developing ED has not been established. Similarly, it is not known if such an intervention will improve symptoms in patients with established ED. The situation is further complicated by the likelihood that one of the rarer side-effects of fibrates and statins is ED. There is a need for appropriately designed trials to establish if intervening with statins or fibrates is beneficial on a short- or long-term basis for the treatment or prevention of ED.

[Should plasma prolactin assay be routinely performed in the assessment of erectile dysfunction? Report of a series of 445 patients. Review of the literature]

OBJECTIVE

To define the value of plasma prolactin assay in the assessment of erectile insufficiency.

MATERIAL AND METHODS

Plasma prolactin assay (radioimmunoassay) was performed in 445 patients presenting with erectile insufficiency (mean age 52.5 years).

RESULTS

9 patients (2%) presented plasma prolactin levels greater than 25 ng/ml and 4 (0.9%) of them had levels higher than 35 ng/ml. Eight of these 9 patients were taking hyperprolactinaemic drugs. The aetiology remained unclear in 1 patient, but the pituitary gland was normal on CT scan.

REVIEW OF THE LITERATURE

In the population of men with erectile insufficiency, 2.7% of subjects have plasma prolactin levels greater than 20 or 25 ng/ml. 1.3% have levels greater than 35 or 40 ng/ml and 0.6% present pituitary tumours. In the case of pituitary tumours responsible hyperprolactinaemia and erectile insufficiency: 1) plasma prolactin is greater than 30 ng/ml in 90% of cases and greater than 50 ng/ml in 83% of cases; 2) total plasma testosterone is less than 3 ng/ml in 88% of cases and less than 4 ng/ml in 96% of cases; 3) libido is decreased in 90% of cases.

CONCLUSION

The prevalence of hyperprolactinemia and pituitary tumours in the population of men with erectile insufficiency is low. Moreover, certain criteria are suggestive of hyperprolactinemia, especially when it is secondary to a pituitary tumour. Consequently, routine plasma prolactin assay is not justified. This assay should only be performed when libido is impaired, total plasma testosterone is decreased or when the patient presents certain signs such as headache, gynaecomastia or visual disturbances.

[Effect of aging and diseases on male sexual function assessed by the International Index of Erectile Function]

PURPOSE

Many epidemiological factors contribute to erectile dysfunction (ED). The objective of the present research was to investigate the risk factors of ED and the influence of aging on male sexual function, to obtain some insight into prevention of ED.

METHODS

The study sample consisted of employees, aged from 22 to 59 years old of ten companies in Japan, who responded to the International Index of Erectile Function (IIEF) questionnaire and a survey of health status and related variables. The IIEF sexual activity questionnaire includes 15 items related to male sexual activity organized into five domains (that is erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) to which 967 of the 1,020 subjects (94.8%) provided complete responses. These 967 men constitute the present study sample. For statistical analysis, ANOVA with Scheffe's (post hoc) test was conducted, and statistical significance was set at p < 0.05.

RESULTS

Presence of hypertension, heart disease, diabetes and hyperlipidemia was associated with a significantly decreased score for erectile function in subjects in their fifties (p < 0.05), however, it was not significant in the other age groups. In subjects, who were free from risk factors for sexual function, there was significant correlation between age and the scores for erectile function, orgasmic function, sexual desire and intercourse satisfaction.

CONCLUSIONS

Aging and chronic disorders that have been considered to be putative risk factors for ED, therefore affect male sexual function in the elderly. The IIEF was suggested to be suited for use in studies assessing epidemiology of ED.

Erectile dysfunction in the community: a prevalence study

OBJECTIVE

To investigate the prevalence of erectile dysfunction (ED) in the South Australian community, and the influence of demographic and other risk factors.

DESIGN

Survey by mailed questionnaire (based on the University of California, Los Angeles prostate cancer index) of a subset (men who agreed to participate) of a probability sample of the South Australian community who completed a multiuser interview survey.

PARTICIPANTS AND SETTING

Men over the age of 40 in South Australia.

MAIN OUTCOME MEASURES

Sexual desire, orgasm, ability to have an erection, adequacy (firmness) of erections for intercourse, frequency of erections when wanted, frequency of intercourse, nocturnal or morning erections, and history of prostate surgery; total sexual function score based on these.

RESULTS

612 men (86.7%) agreed to answer the sexual function survey; 427 (69.8%) returned questionnaires. ED was strongly correlated with age in all seven domains of sexual function. Erections inadequate for intercourse affected 3% of 40-49-year-olds, increasing to 64% of 70-79-year-olds. The frequency of intercourse considered normal for age by men 50-69 years was 1-6 times weekly; the disparity between this and reported frequency increased in men over 60 years, as did the difference between sexual desire and potency. A history of vigorous exercise was protective across all ages. High triglyceride levels, blood pressure medication and non-cancer surgery for prostate disease were independent predictors of poor sexual function at older ages. High cholesterol level was an independent predictor of impotence.

CONCLUSIONS

We found similar or higher levels of ED than in comparable overseas studies. Disparity between potency and desire was greatest, and hence the age group in whom demand for treatment may be highest, in those 60 years and older. Cardiovascular risk factors were predictors of ED in these older men, suggesting that prevention may benefit sexual function. Non-cancer prostate surgery may be a greater contributor to ED than previously realised.

The epidemiology, anatomy, physiology, and treatment of erectile dysfunction in chronic renal failure patients

Erectile dysfunction (ED) is an associated morbidity for men with chronic renal failure. An understanding of the epidemiology, anatomy, physiology, and treatment options for ED can greatly improve the quality of life for men with chronic renal failure. There are psychological and physiological causes for erectile dysfunction. Once the key features leading to the patient's loss of potency have been identified, appropriate treatment plans can be instituted, often with successful outcomes. The purpose of this article is to assist the nephrology interdisciplinary team in the management of ED by reviewing possible causes, available studies, and treatment options for their patients.

Tamsulosin 0.4 mg once daily: effect on sexual function in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction

OBJECTIVE

To evaluate the effect of tamsulosin, 0.4 mg once daily, on sexual function in comparison with placebo and alfuzosin, 2.5 mg three times daily, in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO).

METHODS

Data from 830 patients randomized into three European multicenter studies with similar protocols were analyzed. In two studies, patients were randomized to receive either tamsulosin, 0.4 mg once daily, or placebo, and in the third, patients were randomized to receive either a fixed dose of tamsulosin, 0.4 mg once daily, or alfuzosin, titrated to 2.5 mg three times daily. The studies employed a 2-week placebo run-in period, followed by a 12-week study period. Sexual function was assessed by related adverse events and by a sexual function score determined from a life-style questionnaire.

RESULTS

Abnormal ejaculation occurred significantly more frequently in patients treated with tamsulosin than in those receiving placebo (p = 0.045); however, the incidence of abnormal ejaculation was similar in patients receiving tamsulosin or alfuzosin in the comparative study. Abnormal ejaculation was not perceived as a major problem by the patients since it resulted in few treatment discontinuations (n = 3). It was also reversible on drug withdrawal. There was no difference between tamsulosin and placebo or alfuzosin with regard to the occurrence of decreased libido or impotence. In addition, there was no significant difference in the change in sexual function score between patients treated with tamsulosin and those treated with alfuzosin. Compared with patients receiving placebo, there was, however, a significant improvement in total sexual function score in patients receiving tamsulosin (p = 0.042).

CONCLUSIONS

Tamsulosin, 0.4 mg once daily, is well tolerated and has no overall negative impact on sexual function compared with placebo or alfuzosin. Compared with placebo, tamsulosin may even improve sexual function.

Erectile dysfunction in the aging man

There has been and continues to be a revolution in the treatment available for erectile dysfunction, a disorder that affects quality of life and sense of self-esteem. It should be considered mandatory to assess and discuss this problem in all older men.

Comparative quality-of-life analysis after radical prostatectomy or external beam radiation for localized prostate cancer

OBJECTIVES

To determine and compare quality-of-life (QOL) evaluations from patients who received external beam radiation therapy or radical prostatectomy for the treatment of localized prostate cancer, and to compare differences in QOL assessments for urinary and sexual function after radical prostatectomy as reported by patient and physician.

METHODS

Two hundred three patients treated by radical prostatectomy and 257 patients treated by external beam irradiation, all beyond 12-month follow-up after therapy, responded to a QOL questionnaire. The difference in responses with regard to bladder, bowel, and sexual function, overall satisfaction with treatment, and choice of the same treatment were assessed. Satisfaction with and choice of the same treatment were also specifically assessed according to bowel and bladder function and current disease status. The medical records of patients treated by radical prostatectomy were reviewed by an independent data manager to record the physician's assessment of continence and sexual function for comparison with that patient's assessment as noted in the questionnaire.

RESULTS

Problems with urinary continence were more frequent among patients treated by radical prostatectomy; problems with gastrointestinal function were more frequent after irradiation. Sexual dysfunction was similar in both groups, although surgical patients experienced a greater impact on sexual relationships. The physician estimates of urinary continence were more favorable than the patient-reported outcomes. However, the physician estimate of sexual function closely approximated that of the patient. Preservation of sexual function among patients who underwent nerve-sparing surgery was disappointingly low. Only for the response to the question dealing with difficulty in achieving an erection was there a statistically significant benefit for patients receiving nerve-sparing versus non-nerve-sparing procedures. Patient satisfaction with and choice of the same treatment varied according to function and current disease status. Patients who had incontinence or bowel dysfunction or had evidence of recurrent disease were statistically less likely to choose the same treatment again when compared with functional and disease-free counterparts. Because irradiated patients were on average 6 years older than surgical patients, responses were adjusted for age; adjustment for age did not alter results.

CONCLUSIONS

QOL is determined by the treatment received, by the assessment source, and by the patient's function and disease status at the time of assessment. Prospective and longitudinal studies will more accurately quantify immediate and chronic alterations in QOL. Uniformity of evaluation through consolidation of QOL instruments will permit more accurate cross-series and cross-treatment comparisons.

Sexual function and bother after radical prostatectomy or radiation for prostate cancer: multivariate quality-of-life analysis from CaPSURE. Cancer of the Prostate Strategic Urologic Research Endeavor

OBJECTIVES

To measure the effect of treatment choice (pelvic irradiation [XRT] versus radical prostatectomy [RP] with or without nerve sparing) on sexual function and sexual bother during the first 2 years after treatment.

METHODS

We studied sexual function and sexual bother in 438 men recently diagnosed with early-stage prostate cancer and treated with XRT or RP with or without nerve sparing. Outcomes were assessed with the University of California, Los Angeles Prostate Cancer Index, a validated health-related quality-of-life instrument that includes these two domains. To minimize the influence of other factors, we adjusted for age, comorbidity, general health, and previous treatment for erectile dysfunction. All subjects were drawn from CaPSURE, a national, longitudinal data base.

RESULTS

Sexual function improved over time during the first year in all treatment groups; however, during the second year, sexual function began to decline in the XRT group. Older patients who received XRT showed substantial declines in sexual function throughout the 2 years, and older patients who underwent RP experienced a return of very low baseline sexual function. Sexual function was improved by the use of nerve-sparing procedures or erectile aids. Alterations in sexual bother were ameliorated by many factors, including age, general health perceptions, and sexual function.

CONCLUSIONS

Patients undergoing XRT or RP with or without nerve sparing all showed comparable rates of improvement in sexual function during the first year after treatment for early-stage prostate cancer. However, in the second year after treatment, patients treated with XRT began to show declining sexual function; patients treated with RP did not.

Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies

PURPOSE

We update results in a series of consecutive patients treated with anatomic radical retropubic prostatectomy regarding recovery of erections, urinary continence and postoperative complications.

MATERIALS AND METHODS

One surgeon performed anatomic radical retropubic prostatectomy on 1,870 men, using the nerve sparing modification when feasible. We evaluated recovery of erections and urinary continence in men followed for a minimum of 18 months. Patients who were not reliably potent before surgery, did not undergo a nerve sparing procedure, or received hormonal therapy or postoperative adjuvant radiotherapy were excluded from the analysis of potency rates but not of continence rates. Other postoperative complications were evaluated for the entire patient population.

RESULTS

Recovery of erections occurred in 68% of preoperatively potent men treated with bilateral (543 of 798) and 47% treated with unilateral (28 of 60) nerve sparing surgery. Recovery of erections was more likely with bilateral than with unilateral nerve sparing surgery in patients less than 70 years old (71 versus 48%, p<0.001) compared with patients with age 70 years old or older (48 versus 40%, p = 0.6). Recovery of urinary continence occurred in 92% (1,223 of 1,325 men) and was associated with younger age (p<0.0001) but not with tumor stage (p = 0.2) or nerve sparing surgery (p = 0.3). Postoperative complications occurred in 10% of patients overall and were associated with older age (p<0.002) but the incidence declined significantly with increasing experience of the surgeon (p<0.0001). There was no operative mortality.

CONCLUSIONS

Anatomic radical retropubic prostatectomy with the nerve sparing modification can be performed with favorable results in preserving potency and urinary continence. Better results are achieved in young men with organ confined cancer. Other complications can be reduced with increasing surgeon experience.

Outcome of managing impotence in clinical practice

AIMS

Outside of controlled clinical trials, the outcome of treatment for unselected men with impotence is uncertain. This study aims to describe the clinical course of consecutive, unselected men referred to a specialist endocrinology private practice with a primary diagnosis of impotence.

METHODS

Consecutive men referred with a primary diagnosis of impotence between June 1995 and December 1997 were studied. After initial evaluation and appropriate investigation, treatment with testosterone in hypogonadal men and instruction in the use of a vacuum device and intracavernosal alprostadil (Caverject) in all men was offered. All men were followed up by telephone and/or questionnaire about erection outcome three to twelve months later.

RESULTS

Nineteen diabetic men, aged 53.1+/-8.2 years and forty non-diabetic men, aged 54.8+/-11.6 years were seen. Follow-up information beyond three months was complete in fifty-three (90%). Eighteen eugonadal men chose no further therapy and four of these men had spontaneous return of erections. Eight men were hypogonadal and potency returned in two of six men treated with replacement testosterone. Nine men used the vacuum device, which was effective in three of them. Forty-one men had a trial of Caverject injection, which was effective in twenty-eight. Only twelve of these men used Caverject for longer than six months.

CONCLUSIONS

Return of erections with therapy beyond three months in unselected men with impotence is successful in only about one-third. Unexpected hypogonadism is relatively common in impotent men, but testosterone replacement therapy has a low rate of improving erections. New therapies for impotence need careful follow-up studies to assess their effectiveness in clinical practice.

Bicalutamide monotherapy versus flutamide plus goserelin in prostate cancer patients: results of an Italian Prostate Cancer Project study

PURPOSE

To compare the efficacy of bicalutamide monotherapy to maximal androgen blockade (MAB) in the treatment of advanced prostatic cancer.

PATIENTS AND METHODS

Previously untreated patients with histologically proven stage C or D disease (American Urological Association Staging System) were randomly allocated to receive either bicalutamide or MAB. After disease progression, patients treated with bicalutamide were assigned to castration. The primary end point for this trial was overall survival. Secondary end points included response to treatment, disease progression, treatment safety, quality-of-life (QOL), and sexual function.

RESULTS

A total of 108 patients received bicalutamide and 112 received MAB. There was no difference in the percentage of patients whose prostate-specific antigen returned to normal levels. At the time of the present analysis (median follow-up time, 38 months; range, 1 to 60 months), 129 patients progressed and 89 died. There was no difference in the duration of either progression-free survival or overall survival. However, a survival trend favored bicalutamide in stage C disease but MAB in stage D disease. Overall and subgroup trends were confirmed by multivariate analysis. Serious adverse events and treatment discontinuations were more common in patients receiving MAB (P =.08 and P =.04, respectively). Fewer patients in the bicalutamide group complained of loss of libido (P =. 01) and of erectile dysfunction (P =.002). Significant trends favored bicalutamide-treated patients also with respect to their QOL, namely relative to social functioning, vitality, emotional well-being, and physical capacity.

CONCLUSION

Bicalutamide monotherapy yielded comparable results relative to standard treatment with MAB, induced fewer side effects, and produced a better QOL.

The likely worldwide increase in erectile dysfunction between 1995 and 2025 and some possible policy consequences

OBJECTIVES

To project the likely worldwide increase in the prevalence of erectile dysfunction (ED) over the next 25 years, and to identify and discuss some possible health-policy consequences using the recent developments in the UK as a case study.

METHODS

Using the United Nations projected male population distributions by quinquennial age groups for 2025, the prevalence rates for ED were applied from the Massachusetts Male Aging Study (MMAS) to calculate the likely incidence of ED. The MMAS has the advantage of being the first study to provide population-based rates rather than rates based on clinical samples. All the projections were age-adjusted.

RESULTS

It is estimated that in 1995 there were over 152 million men worldwide who experienced ED; the projections for 2025 show a prevalence of approximately 322 million with ED, an increase of nearly 170 million men. The largest projected increases were in the developing world, i.e. Africa, Asia and South America.

DISCUSSION

The likely worldwide increase in the prevalence of ED (associated with rapidly ageing populations) combined with newly available and highly publicized medical treatments, will raise challenging policy issues in nearly all countries. Already under-funded national health systems will be confronted with unanticipated resource requests and challenges to existing government funding priorities. The projected trends represent a serious challenge for healthcare policy makers to develop and implement policies to prevent or alleviate ED.

Is obesity an underlying factor in erectile dysfunction?

OBJECTIVES

We conducted a study to evaluate the impact of obesity on erectile function in men with erectile dysfunction.

METHODS

Three hundred and twenty-five consecutive patients with erectile dysfunction were evaluated. We classified the men into 2 groups according to body weight: <120% of the ideal body weight, and >/=120%. We compared several erectile capacities and the findings of penile duplex ultrasonography.

RESULTS

There was a statistically significant decrease in the quality of residual erectile function in patients with obesity (penile rigidity grade 1.32 versus 1.62 in the nonobese patients). Obese patients also have an increased prevalence of vascular risk factors based on a review of the medical records and vascular impairment by duplex ultrasound study (43 and 62% in the obese patients versus 30 and 42% in the nonobese patients, respectively, p < 0.05). However, when we focused only on the patients without any vascular risk factors, no significant difference between the 2 groups was noted in the quality of residual erectile function and also the prevalence of penile vascular impairments (p > 0.05).

CONCLUSIONS

These data demonstrate that obesity in itself does not seem to be an underlying factor, but does impose a risk to vasculogenic impotence by developing chronic vascular disease.