Urology Department, Faculty of Medicine, October 6 University, Cairo, Egypt.
Andrology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Int Urol Nephrol. 2020 Jun;52(6):1015-1025. doi: 10.1007/s11255-020-02405-1. Epub 2020 Feb 18.
Erectile dysfunction (ED) was established to be linked to the risk factors of coronary artery disease such as metabolic syndrome, hypertension, diabetes, smoking, obesity and dyslipidemia.
To study the influence of smoking and obesity on penile hemodynamics in patients with erectile dysfunction.
This prospective study was carried out on 130 patients above 40 years and suffering from ED for more than 6 months. Selected patients were divided into four groups: group 1 (nonsmokers/non-obese) N = 36, group 2 (nonsmokers/obese) N = 30, group 3 (smokers/non-obese) N = 34, group 4 (smokers and obese) N = 30. Other risk factors for ED were excluded except dyslipidemia. All patients were subjected to personal history, sexual history, history of medical disorders or operations, evaluation of erectile function using an abridged IIEF-5. Measuring of BMI, fasting lipid profile, blood sugar, TT, prolactin, and PSA was performed. Penile hemodynamics was evaluated using intracavernosal injection of 1 cc Bimix (papaverin + phentolamine) and penile duplex ultrasound measuring the peak systolic velocity (PSV), end diastolic velocity (EDV), resistive index (RI), and cavernosal artery diameter before and after injection.
The mean ages of group 1, group 2, group 3 and group 4 were 50.92 ± 6.52, 55.20 ± 7.18, 50.88 ± 7.66 and 52.30 ± 7.61, respectively, with no statistically significant (p = 0.341). A statistically significant difference observed between mean value of PSV between group 1 and all other groups on both sides and between group 3 and 4. Also, our results recorded a statistically significant difference between mean value of EDV and RI between group 1 and all other groups on both sides. Concerning the change in the cavernosal artery diameter after ICI, there was a significant difference was seen between the following groups 1 and 4, 3 and 4 on both sides and between groups 1 and 2 at right side only. There was a statistically significant difference between the study groups concerning patient's response to ICI (p value 0.000). A significant negative correlation between BMI and total testosterone was recorded (p = 0.001). Regarding the mean value of testosterone, a significant difference was observed between the different four groups (p = 0.002). And a statistically significant difference was reported between group 1 and group 2 (p = 0.004) and group 2 and group 3 (p = 0.007).
Both smoking and BMI are strong risk factors for ED and affect response to ICI and penile duplex parameters (PSV, EDV, RI). Smoking and BMI together cause more deterioration of penile duplex parameters and response to ICI. The effect of smoking on EDV and RI was more than BMI. The effect of BMI on PSV, response to ICI and testosterone levels was more than smoking.
勃起功能障碍（ED）与冠状动脉疾病的危险因素有关，如代谢综合征、高血压、糖尿病、吸烟、肥胖和血脂异常。
研究吸烟和肥胖对患有勃起功能障碍的患者阴茎血液动力学的影响。
本前瞻性研究共纳入 130 名年龄超过 40 岁且患有勃起功能障碍超过 6 个月的患者。选择的患者分为四组：第 1 组（不吸烟/不肥胖）N=36，第 2 组（不吸烟/肥胖）N=30，第 3 组（吸烟/不肥胖）N=34，第 4 组（吸烟和肥胖）N=30。除血脂异常外，排除 ED 的其他危险因素。所有患者均接受个人史、性史、疾病或手术史评估、使用简化 IIEF-5 评估勃起功能。测量 BMI、空腹血脂谱、血糖、TT、催乳素和 PSA。通过阴茎海绵体内注射 1cc 双效混合物（罂粟碱+酚妥拉明）和阴茎双功能超声测量收缩期峰值速度（PSV）、舒张末期速度（EDV）、阻力指数（RI）和注射前后的海绵体动脉直径来评估阴茎血液动力学。
第 1 组、第 2 组、第 3 组和第 4 组的平均年龄分别为 50.92±6.52、55.20±7.18、50.88±7.66 和 52.30±7.61，无统计学意义（p=0.341）。第 1 组和所有其他组在两侧的 PSV 均值之间以及第 3 组和第 4 组之间存在统计学显著差异。此外，我们的结果记录了第 1 组和所有其他组在两侧的 EDV 和 RI 的均值之间存在统计学显著差异。关于 ICI 后海绵体动脉直径的变化，以下各组之间存在显著差异：第 1 组和第 4 组、第 3 组和第 4 组，以及右侧的第 1 组和第 2 组。研究组之间在患者对 ICI 的反应方面存在统计学差异（p 值 0.000）。记录到 BMI 和总睾酮之间存在显著负相关（p=0.001）。关于睾酮的平均值，在不同的四组之间观察到显著差异（p=0.002）。第 1 组和第 2 组（p=0.004）以及第 2 组和第 3 组（p=0.007）之间报告了统计学显著差异。
吸烟和 BMI 都是 ED 的强危险因素，影响 ICI 和阴茎双功能超声参数（PSV、EDV、RI）的反应。吸烟和 BMI 共同导致阴茎双功能超声参数和 ICI 反应的恶化更严重。吸烟对 EDV 和 RI 的影响大于 BMI。BMI 对 PSV、ICI 反应和睾酮水平的影响大于吸烟。
