Cavernous Artery Intima-Media Thickness: A New Parameter in the Diagnosis of Vascular Erectile Dysfunction

Abstract

Introduction A precise characterization of erectile dysfunction (ED) of vascular origin has not yet been achieved. Although cavernous peak systolic velocity (PSV) is generally considered a major parameter, it has many false positives and negatives because of anatomic variations of the cavernous artery course, challenging site of sampling, insufficient caracterization of an early phase of vascular disease, and significant influence of adrenergic tone. Aim We performed a high magnification ultrasonographic study in order to compare functional and morphological parameters of the cavernous artery to PSV and their relation with penile and systemic atherosclerosis. Methods A total of 109 subjects (84 ED patients and 25 controls) evaluated in our andrological center from March 2007 to January 2008 were enrolled in the study. Main Outcome Measures All subjects underwent medical history, erectile function domain of the International Index of Erectile Function, physical examination, routine and sex hormone blood tests, and high resolution echo color doppler evaluation of carotid, femoral and penile districts (acceleration time, intima media thickness [IMT], intima adventitia thickness, caliper before and after intracavernous alprostadil injection [Δ-cavernous calliper]). Results Cavernous parameters were significantly different between ED and controls. Multivariate model showed that IMT was the only predicting parameter for ED of vascular origin. Cavernous IMT showed a strong direct correlation with carotid and femoral IMT. ED patients with two or more cardiovascular risk factors had a significantly higher cavernous IMT. Conclusions An increased cavernous IMT (≥0.3 mm) might predict ED of vascular origin with more accuracy than PSV and could be a sensitive predictor also for systemic atherosclerosis at an earlier phase.

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

“…Carotid IMT may not completely reflect the structural status of such a distant and small vessel-like cavernosal artery. The study of Caretta et al, 16 in which femoral IMT was also measured besides carotid and cavernosal IMT, have shown that femoral IMT was superior to carotid IMT for identifying patients with peripheral vascular disease. In addition, they have found that there is a higher prevalence of atherosclerotic lesions at femoral site.…”

“…However, we do not know what percentage of that group with increased carotid IMT had pathologically increased cavernosal IMT. In their report, Caretta et al 16 used a cutoff level of 0.3 mm for cavernosal IMT and found that there was a linear positive correlation between cavernosal, carotid and femoral IMT. Our patient population was not enough for making such a classification.…”

“…Afterwards, IMT measurements of both cavernosal arteries at proximal tract were performed as previously described 16 and the mean values of six measurements (three for each side) were used for analysis. Before and after (at 5, 10, 20 min) a standardized pharmacostimulation with 60 mg papaverine hydrochloride, 19 PSV and EDV values of cavernosal arteries and percent change of cavernosal caliber were obtained by penile color duplex ultrasonography (P-CDU) at the peno-scrotal junction.…”

“…Results were promising for IMT as a supplementary tool in the ultrasound evaluation of ED along with conventional peak systolic velocity (PSV) and end-diastolic velocity (EDV) measurements. 16 The present study was designed to verify the presence of a possible correlation between carotid and cavernosal IMT, and to evaluate the diagnostic efficacy of IMT in our ED patients.…”

“…13 Carotid IMT values X0.9 mm were considered increased according to the literature. 14 Besides carotid arteries, IMT measurement has been also studied in the lower extremity arteries (femoral and popliteal arteries) 15 and even in such small vessels as cavernosal arteries 16 by the virtue of modern ultrasound technology. Results were promising for IMT as a supplementary tool in the ultrasound evaluation of ED along with conventional peak systolic velocity (PSV) and end-diastolic velocity (EDV) measurements.…”