Huang Wei-Lun, Tung Sheng-Yung, Tseng Chi-Shin, Wang Tzung-Dau, Lee Wen-Jeng, Chen Jyh-Horng, Su Yann-Ron, Chang Hong-Chiang, Chang Yi-Kai
Department of Urology, National Taiwan University Hospital and College of Medicine, Zhongzheng Dist., Taipei City 100225, Taiwan (R.O.C.).
Division of Urology, Department of Surgery, E-Da Hospital, Yanchao Dist. Township, Kaohsiung City 824005, Taiwan (R.O.C.).
J Sex Med. 2025 Jan 9;22(2):282-290. doi: 10.1093/jsxmed/qdae172.
Pelvic arterial (PLA) stenosis is associated with arterial insufficiency of the penis and erectile dysfunction (ED), but the effect of different severities of PLA stenosis on ED remains unclear.
To investigate how different severities of PLA stenosis affect erectile function.
We included patients who visited our clinic for ED and underwent computed tomography angiography (CTA) and dynamic duplex sonography (DUS). The erectile hardness score (EHS), simplified International Index of Erectile Function (IIEF-5), DUS and CTA results, and flow index (FI) calculated from the peak systolic velocity (PSV) and PLA stenosis percentages were analyzed. EHS < 3 was defined as significant ED. PLA stenosis was analyzed by the mean PLA (average of the right and left PLA) and unilateral or bilateral stenoses. According to severity, stenosis was classified as mild, moderate, or severe.
Subjective and objective parameters, including the IIEF-5 score, EHS, PSV, and FI, in relation to different severities of PLA stenosis.
The study included 182 patients. Vascular parameters such as the mean PSV, PLA stenosis, and FI correlated with EHS and IIEF-5 scores. Receiver operating characteristic analyses for predicting EHS ≥ 3 showed that all vascular parameters had acceptable discriminatory ability. During the analysis performed using the mean PSA stenosis, EHS decreased in patients with mild and severe mean PLA stenosis, although a PSV drop was noted only in severe cases. The proportion achieving EHS 3 significantly dropped in patients with at least mild mean PLA stenosis. Using unilateral or bilateral PLA stenosis, the EHS significantly dropped in patients with severe unilateral and bilateral PLA stenosis, with PSV decreasing on the affected side in severe unilateral stenosis. However, the mean PSV did not drop despite different unilateral stenosis severities. The proportion achieving EHS 3 significantly dropped among patients with at least moderate unilateral PLA stenosis and bilateral PLA stenosis but not in mild unilateral cases.
The severity of PLA stenosis is correlated with the risk of ED.
STRENGTHS & LIMITATIONS: The strength of this study lies in its analysis of the effect of PLA stenosis on erectile function from various perspectives, including unilateral, bilateral, and mean stenosis. However, the absence of validation regarding the outcomes of endovascular therapy is a limitation.
Mild mean PLA stenosis and moderate unilateral PLA stenosis are associated with increased risks of ED; however, mild unilateral PLA stenosis does not affect erectile function.
盆腔动脉（PLA）狭窄与阴茎动脉供血不足及勃起功能障碍（ED）相关，但不同严重程度的PLA狭窄对ED的影响尚不清楚。
探讨不同严重程度的PLA狭窄如何影响勃起功能。
我们纳入了因ED前来我院就诊并接受计算机断层血管造影（CTA）和动态双功能超声（DUS）检查的患者。分析勃起硬度评分（EHS）、简化国际勃起功能指数（IIEF-5）、DUS和CTA结果，以及根据收缩期峰值流速（PSV）和PLA狭窄百分比计算的血流指数（FI）。EHS＜3被定义为重度ED。通过平均PLA（左右PLA的平均值）以及单侧或双侧狭窄来分析PLA狭窄情况。根据严重程度，狭窄分为轻度、中度或重度。
主观和客观参数，包括IIEF-5评分、EHS、PSV和FI，与不同严重程度的PLA狭窄相关。
该研究纳入了182例患者。血管参数如平均PSV、PLA狭窄和FI与EHS和IIEF-5评分相关。预测EHS≥3的受试者工作特征分析表明，所有血管参数均具有可接受的鉴别能力。在使用平均PSA狭窄进行分析时，轻度和重度平均PLA狭窄患者的EHS均下降，不过仅在重度病例中观察到PSV下降。至少轻度平均PLA狭窄患者中达到EHS 3的比例显著下降。使用单侧或双侧PLA狭窄时，重度单侧和双侧PLA狭窄患者的EHS显著下降，重度单侧狭窄患者患侧PSV降低。然而，尽管单侧狭窄严重程度不同，平均PSV并未下降。至少中度单侧PLA狭窄和双侧PLA狭窄患者中达到EHS 3的比例显著下降，但轻度单侧病例中未下降。
PLA狭窄的严重程度与ED风险相关。
本研究的优点在于从多个角度分析了PLA狭窄对勃起功能的影响，包括单侧、双侧和平均狭窄。然而，缺乏关于血管内治疗结果的验证是一个局限性。
轻度平均PLA狭窄和中度单侧PLA狭窄与ED风险增加相关；然而，轻度单侧PLA狭窄不影响勃起功能。
