The process of care model for evaluation and treatment of erectile dysfunction

OBJECTIVE:To determine how well a single question of self-reported erectile dysfunction compares to a gold standard clinical urologic examination. DESIGN AND SETTING:Clinical validation study nested within the Massachusetts Male Aging Study (MMAS), which is an observational cohort study of aging and health in a population-based random sample of men.MEASUREMENT: During an in-person interview, men were asked to respond to a single-question self-report of erectile dysfunction. A subsample of MMAS participants was then subjected to a clinical urologic examination to obtain a clinical diagnosis of erectile dysfunction. PARTICIPANTS:One hundred thirty-nine men 55 to 85 years of age from the MMAS. RESULTS:Complete data were available from 137 men. Erectile dysfunction (ED) measured by self-report and independent urologic examination were strongly correlated (Spearman r =.80). Receiver operating curve analysis showed that the self-reported ED item accurately predicts the clinician-diagnosed ED (area under the curve [AUC] =0.888). Stratum-specific likelihood ratios (95% confidence intervals) for selfreports predicting the gold standard were: no ED =0.11 (0.06 to 0.22), minimal ED =1.48 (0.67 to 3.26), moderate ED =8.57 (1.21 to 60.65), and complete ED =12.69 (1.81 to 88.79). These data indicate that men diagnosed with ED by urologic examination can be distinguished from men not diagnosed with ED by urologic examination if the respondent self-reported no, moderate, or complete ED. CONCLUSION:Our single-question self-report accurately identifies men with clinically diagnosed ED, and may be useful as a referral screening tool in both research studies and general practice settings. (Table 1). We have previously shown that self-administration of this single question correlates well with the IIEF and the BMSFI, and that the proportion with missing data for the single question (9%) was similar to that for the BMSFI (8%) and lower than that for the IIEF (18% METHODSThe MMAS is an observational cohort study of health and aging in a population-based random sample of men. The design has been well-described elsewhere. 3,22,23 As part of the in-person interview, respondents were queried about erectile function with a single question. Table 1 presents the ED single question as it was presented to respondents in the MMAS. The substudy was described to all participants at the conclusion of the in-person interview, and each was offered the opportunity to participate. They were told that participation was strictly voluntary and independent of their participation in

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“…24 The components of this approach have been accepted by the U.S. 24,25 and international 26 urologic community.…”

Section: Methodsmentioning

confidence: 99%

The validity of a single-question self-report of erectile dysfunction

et al. 2005

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“…In addition to a medical history, sexual history and physical examination, the proper assessment of ED requires selective laboratory tests, including fasting serum glucose or hemoglobin A1c, fasting lipid profiles and serum testosterone assays (total, free or bioavailable). [31][32][33] While a full review of testosterone therapy is beyond the scope of this article, in general, men with ED and symptoms of hypogonadism (diminished libido and erections, poor responders to PDE-5 inhibitor therapy, less energy, depressed mood, diminished muscle mass and strength) should be assessed with a morning total and free serum testosterone. Low testosterone levels (total testosterone less than 300 ng per 100 ml) in symptomatic men can identify potential candidates for testosterone replacement therapy.…”

Section: Workup For Erectile Dysfunctionmentioning

confidence: 99%

Erectile dysfunction as a harbinger for increased cardiometabolic risk

et al. 2008

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In August 2003, the Minority Health Institute (MHI) convened an Expert Advisory Panel of cardiologists and urologists to design a new practice model algorithm that uses erectile dysfunction (ED) as a clinical tool for early identification of men with systemic vascular disease. The MHI algorithm noted ED as a marker for the presence of cardiovascular disease and suggested that ED may well be a cardiovascular risk equivalent warranting aggressive secondary prevention management strategies, even in the absence of other cardiac or peripheral vascular symptoms. The MHI algorithm stipulates that all men 25 years of age and older should be asked about ED as a routine part of the cardiovascular history during any office visit. The presence of ED should prompt an aggressive assessment for occult vascular disease; many men with erectile difficulty would benefit from early, aggressive management of cardiovascular risk factors with both lifestyle modification and pharmacotherapy to achieve optimal target goals under the existing treatment guidelines. Since publication of the algorithm in 2005, additional research studies have further supported the advisory panel recommendations.

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“…19 With this treatment strategy, patients begin with oral or minimally invasive single agents and if these are not ef®cacious, injectable or intraurethral single-agent therapy is recommended. If this fails, bi and tri-mix injectable therapy will be tested.…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of erectile dysfunction: the contributions of trabecular structure to function and the role of functional antagonism

Moreland

2000

Int J Impot Res

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Erectile dysfunction (ED) is estimated to impact more than 150 million men this year worldwide. An understanding of the pathophysiology of ED both furthers the basic scienti®c knowledge of disease processes and provides a rational design of pharmacotherapy. At present, there are two major views regarding the pathophysiology of ED. In the ®rst hypothesis, the oxygen tensiondependent changes in the penis during erection are proposed to impact corpus cavernosum structure by inducing various cytokines, vasoactive factors and growth factors at the two different oxygen tensions (¯accidity and erection) which, in turn, alter smooth muscle metabolism and connective tissue synthesis. Decreases in the corpus cavernosum smooth muscleaconnective tissue ratio have been correlated with an increased likelihood of diffuse venous leak and a failure of the veno-occlusive mechanism in prospective patient studies. Evidence for such a hypothesis incorporates nocturnal penile tumescence and circadian changes in oxygenation as important in maintaining erectile health. The alternate hypothesis proposes that ED is the result of a metabolic imbalance between relaxatory and contractile processes within the trabecular smooth muscle such that contractile processes predominate. Based on this hypothesis, therapy can be accomplished via drugs which shift this balance towards vasodilatation, or by gene therapy approaches to supplement the de®cient components favoring smooth muscle relaxation. Both of these hypotheses predict a management strategy for ED that impacts pharmacotherapeutics. In this review of the pathophysiology of ED, each hypothesis will be examined and a synthesis devised incorporating both views. The future of research in this area as well as pharmacotherapy in ED in terms of pathophysiology is discussed including the merits and drawbacks of prophylaxis and prevention of ED.

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The process of care model for evaluation and treatment of erectile dysfunction

Cited by 131 publications

References 34 publications

The validity of a single-question self-report of erectile dysfunction

The validity of a single-question self-report of erectile dysfunction

Erectile dysfunction as a harbinger for increased cardiometabolic risk

Pathophysiology of erectile dysfunction: the contributions of trabecular structure to function and the role of functional antagonism

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