Relationship between Response to PDE5 Inhibitors and Penile Duplex Doppler Ultrasound in Erectile Dysfunction

Öğreden, Ercan; Oğuz, Ural; Demirelli, Erhan; Tosun, Alptekin; Yalçın, Orhan

doi:10.3390/medsci6020028

Cited by 2 publications

(2 citation statements)

References 29 publications

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“…Patients with arteriogenic ED still respond to phosphodiesterase type 5 (PDE5) inhibitors 27 – 29 . In patients with mild-to-moderate ED, up to 60% had normal erectile function after treatment with sildenafil 50 mg for 1 year 27 .…”

Section: Discussionmentioning

confidence: 99%

“…These results indicate that the long-term use of PDE5 inhibitors might restore normal erectile tissue by improving endothelial function and penile perfusion. However, one study reported that patients with arteriogenic ED seemed to respond less to PDE5 inhibitors than patients with venous insufficiency or non-arteriogenic ED 29 . The results indicate that an accurate diagnosis of arteriogenic ED is crucial for the treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

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The flow index provides a comprehensive assessment of erectile dysfunction by combining blood flow velocity and vascular diameter

Huang

Tung

Tseng

et al. 2022

Sci Rep

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Dynamic duplex sonography (DUS) is not comprehensive in the evaluation of arteriogenic erectile dysfunction (ED). We introduced a new parameter, the flow index (FI), into the assessment of arteriogenic ED. A retrospective review of a prospective database was conducted. Patients undergoing DUS and pelvic computed tomography angiography for the evaluation of ED were included. The FI was calculated from peak systolic velocity (PSV) and the percentages of pelvic arterial (PLA) stenosis. Correlations between PSV, PLA stenosis, the FI, and erectile function were calculated. Eighty-three patients were included. Compared with PSV, the FI had better correlations with the erection hardness score (EHS) (rs = 0.405, P < 0.001 for FI; rs = 0.294, P = 0.007 for PSV). For EHS < 3, the areas under the ROC curve of FI and PSV were 0.759 and 0.700, respectively. In patients with normal DUS but EHS < 3, PLA stenosis was more severe (62.5% vs. 10.0%, P = 0.015), and the FI was lower (8.35 vs. 57.78, P = 0.006), while PSV was not different. The FI is better than PSV in the evaluation of arteriogenic ED. On the other hand, assessment of the pelvic arterial system should be included in the evaluation of ED.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The flow index provides a comprehensive assessment of erectile dysfunction by combining blood flow velocity and vascular diameter

Huang

Tung

Tseng

et al. 2022

Sci Rep

View full text Add to dashboard Cite

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A novel algorithm-based risk classification for vascular damage in men with erectile dysfunction

Belladelli,

Cei,

Pozzi

et al. 2024

The Journal of Sexual Medicine

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Background Penile dynamic color doppler duplex ultrasound (CDDU) is a relevant tool in assessing men with suspected vasculogenic erectile dysfunction (V-ED). Aim To investigate (1) factors potentially associated with V-ED to define risk classes useful in predicting V-ED; (2) the response to phosphodiesterase type 5 inhibitors (PDE5i); and (3) the onset of incident major cardiovascular (CV) events. Methods A cohort of men with ED and without known concomitant CVD was grouped into: patients undergoing CDDU (N. 301) and patients not undergoing CDDU but prospectively monitored for incident major CV events after initiating PDE5i (N. 127). Logistic regression and Chi-square Automatic Interaction Detectors (CHAID) methodology were employed to identify potential predictors and develop a novel risk classification system. Receiver operating characteristic (ROC) curves and decision curve analysis was performed to assess its accuracy. Outcomes Factors associated with V-ED useful to develop a novel risk classification system predicting incident major CV events and PDE5i response. Results The new classification defines patients as follows: Very Low Risk [age < 53, body mass index (BMI) < 25 Kg/m2], Low Risk (age < 53, BMI > 25 Kg/m2, non-smokers), Moderate Risk (age > 53, non-smokers), High Risk (age < 53, BMI > 25 Kg/m2, smokers), and Very High Risk (age > 53, smokers). Multivariable logistic regression analysis highlighted age, BMI, and smoking as significant predictors of V-ED. CHAID methodology yielded a risk classification system with an accuracy of 0.79. Notably, “Very High Risk” class was associated with a significantly increased risk of incident major CV events [odds ratio (OR) 4.00, 95% confidence interval (CI) 1.06–15.08, P < .05]. Moreover, patients belonging to “Very High Risk” and “High Risk” classes were also associated with diminished PDE5i response. At Kaplan–Meier analysis, men belonging to “Very High Risk” class depicted a notable risk of incident major CV events (P = .03). Clinical implications We propose a novel risk classification system which may have some clinical value in tailoring patients at significantly higher risk of V-ED. Although preliminary, current findings also suggest that the novel risk classification system could help tailoring men at potential increased risk of incident major CV events and those not responding to PDE5i. Strengths and Limitations This study introduces a novel user-friendly risk stratification tool for V-ED, emphasizing the need for CV screening and alternative therapies for higher-risk groups. A limited number of events in the cohort with follow-up for major CV events and response to PDE5is constrains the interpretation of the results. Current findings need an external validation cohort. Conclusion Patients with ED categorized as either “Very High Risk” or “High Risk” should undergo a CDDU due to an increased risk of V-ED. Additionally, despite the clinical impact of these findings need further investigation, patients classified as “Very High Risk” could face a heightened risk of major CV events and a lower response to PDE5is.

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Relationship between Response to PDE5 Inhibitors and Penile Duplex Doppler Ultrasound in Erectile Dysfunction

Cited by 2 publications

References 29 publications

The flow index provides a comprehensive assessment of erectile dysfunction by combining blood flow velocity and vascular diameter

The flow index provides a comprehensive assessment of erectile dysfunction by combining blood flow velocity and vascular diameter

A novel algorithm-based risk classification for vascular damage in men with erectile dysfunction

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