The combined use of brachial artery flow-mediated dilatation and carotid artery intima-media thickness measurements may be a method to determine vasculogenic erectile dysfunction

Abstract

The aim of this study was to investigate the relationship between penile color Doppler sonography (CDS) findings and sonographic endothelial parameters in patients with erectile dysfunction (ED), including intima-media thickness (IMT) of common carotid arteries (CCA) and flow-mediated dilatation (FMD) of brachial artery. Fifty-six ED patients were included in the study. Penile CDS, IMT of CCA and FMD of brachial artery were performed in all patients. According to penile CDS findings, 27 (48%) patients had non-vasculogenic and 29 (52%) patients had vasculogenic ED. Among 29 patients, 17 (30%) patients had cavernous veno-occlusive disease (CVOD) and 12 (22%) patients had arterial/combined insufficiency (AI). Median (interquartile range) FMD values of nonvasculogenic ED, CVOD and AI were 12.50 (6.54)%, 12.82 (7.41)% and 6.25 (7.17)%, respectively. FMD was found to be impaired significantly in AI group when compared to the other groups. FMD values of CVOD group were lower when compared to non-vasculogenic group, but the difference was not statistically significant. IMT values of vasculogenic ED patients were higher than nonvasculogenic ED patients (Po0.05). Although IMT values were higher in AI group when compared to CVOD, the difference was not statistically significant. The combined use of IMT and FMD established the diagnosis of vasculogenic ED with 100% sensitivity and 59.2% specificity. The positive predictive value was 72%, negative predictive value 100% and accuracy 80%. The combined use of brachial artery FMD and carotid arteries IMT measurements may be suggested as an alternative method to evaluate vasculogenic ED.

Is there a concordance between carotid and penile cavernosal artery intima-media thickness in patients with erectile dysfunction?

“…13,23,24 In the study of Bocchio et al, 23 it was demonstrated that men with CVRFs and a high carotid IMT level had more severe ED and ED was the only clinical correlate of silent common carotid artery atherosclerosis. In another study, Ucar et al 25 reported that carotid IMT values of vasculogenic ED patients were higher than nonvasculogenic ED patients. Our results did not agree Carotid IMT o0.9 mm (n ¼ 32)…”

The endothelial cell in health and disease: its function, dysfunction, measurement and therapy

“…Perhaps PDE5 inhibitors can enhance the diagnostic capacity. 80 Ucar et al 82 reported that the combined use of brachial artery FMD and carotid artery intima-media thickness diagnoses vasculogenic ED with high accuracy. Furthermore, among patients with vasculogenic ED, brachial artery FMD differentiated between arterial insufficiency and cavernous veno-occlusive disease.…”

“…Furthermore, among patients with vasculogenic ED, brachial artery FMD differentiated between arterial insufficiency and cavernous veno-occlusive disease. 82 Endothelialdependent vasodilation of the cavernous arteries is being elicited using a special sphygmomanometric cuff inflated at the base of the penis to suprasystolic pressure for 5 min, similar to blood pressure cuffinduced FMD of the brachial artery. Using these methods Mazo et al 83,84 showed that a PDE5 inhibitor increased FMD in both penile and brachial arteries.…”

“…Various methods of endothelial function measurement are being used in research studies to establish and further elucidate the link between endothelial dysfunction and ED 4,6,8,9,[85][86][87][88] with the goal of establishing a simple diagnostic test for vasculogenic ED. [80][81][82][83][84][89][90][91] Clinical implications of endothelial function testing…”

Assessment of endothelial function in the patient with erectile dysfunction: an opportunity for the urologist

“…Very recently, several groups 99,100 have demonstrated that the severity of the endothelial dysfunction correlated with ED etiology. Endothelial function was significantly worse in subjects with arteriogenic ED as demonstrated by penile Doppler than in patients with other forms of ED (psychogenic, venous occlusive dysfunction).…”