Lack of Diagnostic Tools to Prove Erectile Dysfunction: Consequences for Reimbursement?

Lehmann, Kurt; Eichlisberger, R.; Gasser, Thomas C.

doi:10.1016/s0022-5347(05)67980-3

Cited by 16 publications

(11 citation statements)

References 23 publications

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“…A body of compelling scientific evidence indicates that pharmacological testing and the duplex Doppler ultrasonography are neither valid nor reliable measures for determining the presence or severity of ED. 67 These tests are known to have low sensitivity, specificity, and reproducibility. 67 Therefore, it is not surprising that physiological or pharmacological tests may be at odds with validated patient reports of sexual dysfunction, including the SHIM.…”

Section: Discussionmentioning

confidence: 99%

“…67 These tests are known to have low sensitivity, specificity, and reproducibility. 67 Therefore, it is not surprising that physiological or pharmacological tests may be at odds with validated patient reports of sexual dysfunction, including the SHIM. 54,63 Even if such laboratory tests were accurate for a limited purpose, sexual (and even erectile) dysfunction has multiple facets that extend beyond the limited range of function measured by such laboratory tests.…”

Section: Discussionmentioning

confidence: 99%

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The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience

2005

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The Sexual Health Inventory for Men (SHIM) is a widely used scale for screening and diagnosis of erectile dysfunction (ED) and severity of ED in clinical practice and research. In reviewing the SHIM-related literature, we sought to provide a compendium of studies in which the SHIM was used, to provide a systematic framework for organizing and evaluating the studies, and to provide a status report on the SHIM and its impact on the management of male sexual dysfunction. Using a Medline search, we found that the SHIM was an integral measure in at least 21 studies on the prevalence of ED, 23 studies on the efficacy of ED interventions, and eight other (mainly correlational) studies. The quantity of research and quality of scholarship on the SHIM provide testimony to its positive impact on understanding and improving male sexual function. These scientific contributions are likely to remain influential in coming years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience

2005

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“…1 -4 There is considerable controversy about the relative importance of each of these factors in the initiation and maintenance of an erection, especially the role of serum levels of testosterone. 2,5 Several studies have documented that aging in men is associated with a decrease in sexual interest and activity, and particularly with an increased prevalence of erectile dysfunction. 1,6 In the MMAS study a prevalence of 20% of hypogonadism for the men over 55 y of age was observed, when the TT levels below the normal rate for young, healthy subjects were considered.…”

Section: Introductionmentioning

confidence: 99%

Is there any relation between serum levels of total testosterone and the severity of erectile dysfunction?

et al. 2002

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The objective of this study was to correlate the severity of erectile dysfunction (ED) with the total testosterone serum levels (TT) in a normal population. During a screening program for the early diagnosis of prostate cancer, 1071 men aged from 40 to 90 y, were invited to answer the questionnaire of the Simplified International Index of Erectile Function (IIEF-5) as a method to diagnose and classify ED. The IIEF-5 scores ranged from 1 to 25 and the ED was classified into five groups according to the scores: severe (1 -7), moderate (8 -11), mild -moderate (12 -16), mild (17 -21) and no . Besides the questionnaire, all subjects had their TT serum levels determined based on the blood sample obtained between 08:00 and 10:00. The analysis of the relationship between the different degrees of ED and TT levels was then studied. Of the 1071 men, 965 were included in the study (90.1%). Eighty-eight percent of these were Caucasian and 12% black. The mean age of the population was 60.7 y. The prevalence of all degrees of ED was 53.9%. The degree of ED was mild in 21.5%, mild to moderate in 14.3%, moderate in 6.3% and severe in 11.9%. The variation of TT serum concentrations was similar (P > 0.05) in the different age groups. Furthermore, the TT serum levels were not different for individuals with and without ED (P > 0.05) and similar concentrations of TT was observed in the different severity degrees of ED (P > 0.05). Only one (0.7%) man in the group of individual with maximal score had subnormal levels of TT. ED presented a clear association with the subjects' aging, but neither correlation between TT levels and ED, nor with its severity, could be demonstrated in the present study.

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“…The assessment of blood flow parameters, intracavernous pressure or venous leakage on pharmacostimulated erections evaluate aspects of erectile function under nonsexual conditions. This may explain the inconsistent results between the patient's self-evaluation and measured parameters [13]. The concept of complete smooth muscle relaxation [14] by injecting repetitive doses of intracavernous vaso-active drugs to its maximal effect may overcome the limits of tests based on pharmacostimulation.…”

Section: Discussionmentioning

confidence: 99%

The Patient’s Self-Evaluation Better Predicts the Degree of Erectile Dysfunction than the Response to Intracavernous Alprostadil Testing

Casella¹,

Deckart²,

Bachmann³

et al. 2004

Urol Int

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Objectives: A modern baseline assessment of erectile dysfunction (ED) should be individualized, reliable, noninvasive and cost-efficient. Appraisal based on the patient’s self-evaluation may be the method of choice. Methods: Using a self-report method, 63 consecutive ED patients were prospectively investigated. Semiquantitative parameters on 7 criteria were assessed, and an intracavernous injection test with alprostadil was performed. Performances of self-reporting and intracavernous testing in predicting penetrative ability were compared. Results: Twenty-three (37%) men had erection insufficient for penetration even with manual assistance, 26 (41%) men needed manual assistance and 14 (22%) could penetrate without manual assistance but erection was not sufficient for satisfaction. In addition to impaired penetrative ability, 6 criteria (intercourse frequency, patient’s and partner’s satisfaction, penile rigidity, duration of erection and need for extra stimulation) deteriorated over time (p < 0.006). Patient self-evaluation criteria such as intercourse per week, patient satisfaction, penile rigidity, duration of erection and time between consultation and last satisfactory intercourse showed discriminating differences in accordance with the 3 subgroups of penetrative ability (p < 0.02). Intracavernous testing could not reproduce the degree of erectile deficit as experienced during intercourse (p = 0.21). In a logistic regression model, criteria best characterizing penetrative ability were penile rigidity, time between consultation and last unsuccessful intercourse, and degree of satisfaction (p < 0.0001). Conclusions: The patient’s self-evaluation by semiquantitative parameters on criteria characterizing sexual erections better predicts the penetrative ability than the response to an intracavernous injection. These criteria quantify both the objective degree of ED and the patient’s apprehension. Consequently, patients may undergo immediate treatment without further testing.

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Lack of Diagnostic Tools to Prove Erectile Dysfunction: Consequences for Reimbursement?

Abstract: Erectile dysfunction could not be defined by pharmacostimulated erections but relevant erectile dysfunction was honestly reported. New and reliable tests for clinical assessment are required to support the application for reimbursement of treatment expenses for erectile dysfunction.

Cited by 16 publications

References 23 publications

The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience

The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience

Is there any relation between serum levels of total testosterone and the severity of erectile dysfunction?

The Patient’s Self-Evaluation Better Predicts the Degree of Erectile Dysfunction than the Response to Intracavernous Alprostadil Testing

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