Debora Marchiori, Daniele Aloisi, Alessandro Bertaccini, Ferri Claudio, Giuseppe Martorana
Dpt. Urology, Alma Mater Studiorum University of Bologna, Italy.
Arch Ital Urol Androl. 2010 Dec;82(4):159-63.
Many authors have demonstrated that cardiovascular diseases (CVD) and their related risk factors can predict erectile dysfunction (ED). The penile Doppler ultrasonography is a method to evaluate the cavernous blood flow in people with suspected vasculogenic impotence. The goal of our study was to evaluate if erectile dysfunction is associated to a vascular disease and which is the role of penile Doppler investigation.
90 patients (group 1) complaining ED, but no symptoms of CVD were prospectively evaluated with penile Doppler ultrasound. The controls (group 2) were 45 apparently healthy subjects. Both groups were submitted to carotid and aortal-iliac Doppler ultrasonography.
50 patients (mean age 60.5 +/- 4.6 years) in group 1 (IIEF < 15) and 45 subjects (mean age 59.5 +/- 4.6 years) in group 2 (IIEF > 15) were recruited. Mean age, height, LDL-cholesterol and blood pressure value were not statistically different (p = 0.417) between the two groups. Statistically significant differences were found in weight values (p = 0.016). Only 8 patients (4%) were affected by arterial insufficiency and 42.1% by veno-occlusive mechanism insufficiency (p > 0.05). The cavernosal artery diameters were within 0.7 +/- 0.2 and 1.2 +/- 0.1 mm. All patients with a diagnosis of vasculogenic impotence of either arterial or venous origin were found asymptomatically affected by both a diffuse thickenings > 1 mm or a non hemodynamic plaque in the other vessels examined (carotid arteries or aorta or iliac arteries).
Looking at our results, erectile dysfunction is associated to diffuse thickness > 1 mm or with a non hemodynamic plaque of atherosclerotic origin in other vessels. These data confirm the theory that impotence has to be considered as a risk marker for cardiovascular disease (CVD) in men with no cardiovascular symptoms. In our opinion, the penile echo Doppler is not able to show any endothelial dysfunction in terms of loss of mediator releasing.
In case of suspect vasculogenic impotence, even if penile Doppler is not pathological, it would be worth performing a systemic Doppler evaluation of main arteries in order to investigate the presence of atherosclerotic finding and institute a preventive therapy for CVD.
许多作者已证明心血管疾病（CVD）及其相关危险因素可预测勃起功能障碍（ED）。阴茎多普勒超声检查是一种评估疑似血管性阳痿患者海绵体血流的方法。我们研究的目的是评估勃起功能障碍是否与血管疾病相关，以及阴茎多普勒检查的作用是什么。
对90例主诉有ED但无CVD症状的患者（第1组）进行前瞻性阴茎多普勒超声评估。对照组（第2组）为45名明显健康的受试者。两组均接受颈动脉和腹主动脉-髂动脉多普勒超声检查。
招募了第1组中的50例患者（平均年龄60.5±4.6岁，国际勃起功能指数＜15）和第2组中的45名受试者（平均年龄59.5±4.6岁，国际勃起功能指数＞15）。两组之间的平均年龄、身高、低密度脂蛋白胆固醇和血压值无统计学差异（p = 0.417）。体重值存在统计学显著差异（p = 0.016）。仅8例患者（4%）存在动脉供血不足，42.1%存在静脉闭塞机制不足（p＞0.05）。海绵体动脉直径在0.7±0.2和1.2±0.1毫米之间。所有诊断为动脉或静脉源性血管性阳痿的患者在检查的其他血管（颈动脉、主动脉或髂动脉）中均无症状性地出现弥漫性增厚＞1毫米或非血流动力学斑块。
从我们的结果来看，勃起功能障碍与其他血管中＞1毫米的弥漫性增厚或动脉粥样硬化起源的非血流动力学斑块相关。这些数据证实了这样一种理论，即对于无心血管症状的男性，阳痿应被视为心血管疾病（CVD）的风险标志物。我们认为，阴茎回声多普勒在介质释放丧失方面无法显示任何内皮功能障碍。
在怀疑血管性阳痿的情况下，即使阴茎多普勒检查无异常，对主要动脉进行系统性多普勒评估以调查动脉粥样硬化发现并制定CVD预防性治疗方案也是值得的。
