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Incidence of extragenital vascular disease in patients with erectile dysfunction of arterial origin


This research was carried out to evaluate the prevalence of carotid and/or lower limb artery abnormalities in patients with arterial erectile dysfunction (ED). To this end, patients with ED (Andrology Unit) or suspected peripheral atherosclerosis (Angiology Unit) underwent an independent and parallel echo-Duplex examination. The Andrology Unit examined 167 patients with ED of different etiologies: 52 of them had penile artery insufficiency and consequently their carotids and lower limb arteries had to be evaluated by means of echo-Doppler. In all, 36 out of the 46 patients with nonarterial organic ED and 22 out of the 69 patients with nonorganic ED underwent the same evaluation and served as controls. The Angiology Unit enrolled 457 ED patients who initially underwent echo-Doppler for suspected carotid and/or arterial leg atherosclerosis and subsequently dynamic echo-Doppler. Isolated penile artery insufficiency was found in 23.1 and 25% of the patients evaluated in the Angiology and Andrology Units, respectively. The remaining patients were shown to have ED associated with an atheroma or marked intima-media thickness of the carotid vessels and/or of leg arteries. The frequency of penile arterial insufficiency and of carotid and/or lower limb artery abnormalities was significantly higher (P<0.01) compared to that found in patients with ED of nonarterial organic or psychogenic origin. Both Units found that the frequency of penile artery insufficiency and carotid or lower limb artery abnormalities was significantly higher than that of penile artery insufficiency alone or plus both carotid and lower limb artery abnormalities. This study showed that penile artery insufficiency is associated with carotid and/or lower limb artery ultrasound abnormalities in about 75% of the cases. Therefore, arterial ED may be regarded as a sign of a more generalized atherosclerosis.

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  1. NIH Consensus Development Panel on Impotence. NIH Consensus Conference. Impotence. J Am Med Assoc 1993; 270: 83–90.

  2. Feldman HA et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151: 54–61.

    Article  CAS  PubMed  Google Scholar 

  3. Rosen RC et al. The multinational Men's Attidudes to Life Events and sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Curr Med Res Opin 2004; 20: 607–617.

    Article  PubMed  Google Scholar 

  4. Chew KK et al. Erectile dysfunction in general medicine practice: prevalence and clinical correlates. Int J Impot Res 2000; 12: 41–45.

    Article  CAS  PubMed  Google Scholar 

  5. Braun M et al. Epidemiology of erectile dysfunction: results of the ‘Cologne Male Survey’. Int J Impot Res 2000; 12: 305–311.

    Article  CAS  PubMed  Google Scholar 

  6. Marumo K, Murai M . Aging and erectile dysfunction: the role of aging and concomitant illness. Int J Urol 2001; 8: S50–S57.

    Article  CAS  PubMed  Google Scholar 

  7. Virag R, Bouilly P, Frydman D . Is impotence an arterial disorders? A study of arterial risk factors in 440 impotent men. Lancet 1985; 26: 181–184.

    Article  Google Scholar 

  8. Morley JE et al. Relationship of penile brachial pressure index to myocardial infarction and cerebrovascular accidents in older men. Am J Med 1988; 84: 445–448.

    Article  CAS  PubMed  Google Scholar 

  9. Jensen J et al. The prevalence and etiology of impotence in 101 male hypertensive outpatients. Am J Hypertens 1999; 12: 271–275.

    Article  CAS  PubMed  Google Scholar 

  10. Jackson G . Erectile dysfunction and cardiovascular disease. Int J Clin Pract 1999; 53: 363–368.

    CAS  PubMed  Google Scholar 

  11. Feldman HA et al. Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts aging study. Prev Med 2000; 30: 328–338.

    Article  CAS  PubMed  Google Scholar 

  12. Cappelleri JC et al. Diagnostic evaluation of the erectile function domain of the international index of erectile dysfunction. Urology 1999; 54: 346–351.

    Article  CAS  PubMed  Google Scholar 

  13. Joint National Committee on prevention, detection, evaluation and treatment of high pressure. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high pressure (JNC VI). Arch Intern Med 1997; 157: 2413.

  14. Bluth EI, Wetzner SM, Stavros AT . Carotid duplex sonography: a multicenter recommendation for standardized imaging and Doppler criteria. Radiographics 1988; 8: 487.

    Article  CAS  PubMed  Google Scholar 

  15. Moneta GL, Yeager RS, Antonovic R . Accuracy of lower extremity arterial duplex mapping. J Vasc Surg 1992; 15: 275.

    Article  CAS  PubMed  Google Scholar 

  16. Salonen R, Salonen JT . Determinant of carotid intima-media thickness: a population-based ultrasonography study in eastern Finnish men. J Intern Med 1991; 229: 225–231.

    Article  CAS  PubMed  Google Scholar 

  17. Meuleman EJH et al. Assessment of penile blood flow by duplex ultrasonography in 44 men with normal erectile potency in different phases of erection. J Urol 1992; 147: 51–56.

    Article  CAS  PubMed  Google Scholar 

  18. Bortolotti A, Parazzini F, Colli E, Landoni M . The epidemiology of erectile dysfunction and its rik factors. Intern J Androl 1997; 20: 323–334.

    Article  CAS  Google Scholar 

  19. Chung WS, Shim BS, Park YY . Hemodynamic insult by vascular risk factors and pharmacological erection in men with erectile dysfunction: Doppler sonography study. World J Urol 2000; 18: 427–430.

    Article  CAS  PubMed  Google Scholar 

  20. Ryu JK et al. Expression of cavernous transforming growth-factor beta1 and its Type II receptor in patients with erectile dysfunction. Intern J Androl 2004; 27: 42–49.

    Article  CAS  Google Scholar 

  21. Montorsi F et al. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol 2003; 44: 360–364; discussion 364–365.

    Article  PubMed  Google Scholar 

  22. Kloner RA, Speakman M . Erectile dysfunction and atherosclerosis. Curr Atheroscler Rep 2002; 4: 397–401.

    Article  PubMed  Google Scholar 

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We thank David Farrugia, Lecturer, Faculty of Economics, University of Catania, for the English text editing.

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Correspondence to A E Calogero.

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Vicari, E., Arcidiacono, G., Di Pino, L. et al. Incidence of extragenital vascular disease in patients with erectile dysfunction of arterial origin. Int J Impot Res 17, 277–282 (2005).

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  • erectile dysfunction
  • risk factors
  • extragenital arterial Eco-Duplex changes

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