Should patients with erectile dysfunction be evaluated for cardiovascular disease?

Canadian Urological Association guideline: Erectile dysfunction

Erectile dysfunction (ED) impacts the wellness and quality of life of millions of Canadians. An evaluation focused on the identification of reversible and irreversible underlying factors is recommended for patients presenting with ED. Through a shared decision-making model framework, the goal of ED treatment is to improve functional outcomes and enhance sexual satisfaction while minimizing adverse effects associated with treatment. Given that ED is assessed and treated by multiple different types of health practitioners, the purpose of this guideline is to provide the best available evidence to facilitate care delivery through a Canadian lens. After a narrative review of ED assessment and treatment for general readership, five key clinical questions relating to priority areas of ED are assessed using the GRADE and evidence-to-decision-making frameworks.

Relationship between the two surgical access of aortoiliac occlusive disease and recovery of ED

Aortoiliac occlusive disease (AIOD) can occur anywhere from the distal abdominal aorta to the common femoral arteries. Patients with AIOD may be asymptomatic or may have intermittent claudication or critical limb ischemia. ED in the young males may be the first symptom of aortoiliac disease. The aims of this study were to determine the outcome of ED in patients who underwent aortoiliac surgery and evaluate the effect of revascularization upon erectile function (EF) by using the international index of EF questionnaire and color duplex Doppler ultrasonography. A total of 60 patients under 65-year-old age eligible for elective repair of AIOD s were included in this study. The patients were randomly divided into two equal groups. The first group (group A) patients were operated by minimally invasive retroperitoneal approach (RPA) and the second group (group B) patients were operated by transperitoneal approach (TPA) to the aorta. The quality of sexual function scale was evaluated preoperatively and at 6 months postoperatively. Surgical revascularization when appropriate, symptomatic AIOD and ED are often improved. As a result of our study, RPA to the aorta is superior to TPA because of recovering with the higher systolic velocity values of penile Doppler in ED cases.

Impaired flow-mediated vasodilatation in Asian Indians with erectile dysfunction

Endothelial dysfunction is the postulated link between coronary artery disease (CAD) and erectile dysfunction (ED). Brachial artery flow-mediated vasodilatation (FMD) is a non-invasive surrogate marker for endothelial function assessment. Despite Asian Indians representing a considerable global CAD burden, data on FMD and ED in these patients are lacking. Of the 225 patients undergoing coronary angiography, 72% had ED (assessed using the International Index of Erectile Function (IIEF-5) questionnaire); ED was moderate to severe in 61% of the patients. ED patients had a higher incidence of severe and diffuse angiographic CAD, a greater number of coronary vessels involved and a lower mean brachial artery FMD (6.40%±4.60% vs. 9.10%±4.87%, P<0.001) compared to non-ED patients. A progressive reduction in FMD was noted with increasing severity of ED. Impaired FMD (≤5.5%) was twice as common in ED patients (52% vs. 24% without ED). Patients with impaired FMD had higher ED prevalence (85% vs. 62%) and lower mean IIEF-5 scores compared to those with normal FMD. Impaired FMD was a significant ED predictor independent of other risk factors (odds ratio, 2.33; 95% confidence interval: 0.59-9.23; P=0.03). An inverse correlation between FMD and ED severity was observed (r=-0.22; P=0.004). ED is common among Asian Indians with angiographically documented CAD. Patients with ED have impaired FMD independent of other risk factors, suggesting that endothelial dysfunction is the underlying pathophysiology. Urologists and cardiologists need to be aware of the association between ED, CAD and endothelial dysfunction.